Publications by authors named "Douglas L Delahanty"

100 Publications

Study Title-Based Framing Effects on Reports of Sexual Violence and Associated Risk Factors in College Students.

J Interpers Violence 2021 May 15:8862605211016349. Epub 2021 May 15.

Kent State University, OH, USA.

Objective: There are many methodological issues in studying sexual violence, including potential framing effects. Framing effects refer to how researchers communicate the purpose of a study to participants, such as, how the study is advertised or explained. The aim of this study was to investigate if framing effects were associated with differences in participants' self-reported experiences of sexual violence and related correlates.

Methods: College students ( = 782) were recruited to participate in one of four identical studies that differed in the title: "Questionnaires about Alcohol," "Questionnaires about Crime," "Questionnaires about Health," or "Questionnaires about Sexual Assault." Participants chose one of the four studies and completed measures of sexual violence as well as attitudinal and behavioral measures in randomized order.

Results: We found significantly more reports of childhood sexual abuse (33.6% vs. 18.5%), rape (33.9% vs. 21.1%), higher frequency of victimization ( = 11.35 vs. 5.44), and greater acknowledged rape for bisexual people (46.2% vs. 0.0%) in the sexual assault (SA) condition compared to other conditions. There were no differences in sexual violence perpetration or attitudinal or behavioral measures.

Conclusion: These results revealed that framing effects, based on the study title, affect outcomes in sexual victimization research. Rape was reported 1.6× more in the "Sexual Assault" condition than in the "Health" condition. It is unclear whether these framing effects reflect self-selection bias or framing related increased reports in the SA condition, suppression of reports in other conditions, or a combination thereof.
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http://dx.doi.org/10.1177/08862605211016349DOI Listing
May 2021

Boosting positive mood in medical and emergency personnel during the COVID-19 pandemic: preliminary evidence of efficacy, feasibility and acceptability of a novel online ambulatory intervention.

Occup Environ Med 2021 Apr 26. Epub 2021 Apr 26.

Department of Psychological Sciences, Kent State University, Kent, Ohio, USA.

Objectives: The aim of this project was to test the efficacy of a brief and novel online ambulatory intervention aimed at supporting psychological health and well-being for medical personnel and first responders during the COVID-19 pandemic.

Methods: Interested participants, n=28, actively employed as medical personnel, support staff and emergency responders, in the Midwestern USA in May-June of 2020, provided informed consent and were randomised to complete either low-dose or high-dose intervention, one time daily for 1 week via smartphone application. Each daily intervention included expressive writing, adaptive emotion regulation activity and (one vs two) positive emotion-generation activities, lasting 3-6 min a day. Ratings of negative and positive emotion were provided before and after each activity daily. Analyses tested compliance, acceptability, as well as efficacy at increasing positive emotion and decreasing negative emotion with each use and across time.

Results: The results indicated a 13% increase in positive emotion, t(25)=2.01, p=0.056; and decrease in negative emotion by 44%, t(25)=-4.00, p=0.001 across both doses. However, there was a clear advantage for individuals in the high-dose condition as daily boosts in positive emotion were significantly greater (an additional 9.4%) B=0.47, p=0.018. Overall, compliance was good. Acceptability ratings were good for those who completed the follow-up assessment.

Conclusion: Front-line personnel, including medical staff and emergency responders, are experiencing unprecedented psychological stress during the COVID-19 pandemic. This investigation suggests both feasibility and efficacy for a brief, daily, ambulatory intervention which could provide essential psychological support to individuals at risk in the workplace.
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http://dx.doi.org/10.1136/oemed-2021-107427DOI Listing
April 2021

Impact of Surgical Status, Loneliness, and Disability on Interleukin 6, C-Reactive Protein, Cortisol, and Estrogen in Females with Symptomatic Type I Chiari Malformation.

Cerebellum 2021 Mar 6. Epub 2021 Mar 6.

Department of Neurosurgery, Johns Hopkins Medical Center, Baltimore, MD, USA.

Chiari malformation type I (CMI) provides an opportunity for examining possible moderators of allostatic load. CMI patients who had (n = 43) and had not (n = 19) undergone decompression surgery completed questionnaires regarding pain, disability, and loneliness, and provided serum samples for IL-6, CRP, estrogen, and free estradiol assays, and saliva samples to assess diurnal cortisol curves. ANOVAs examining surgical status (decompressed versus non-decompressed), loneliness (high vs. low), and disability (high vs. low) as independent variables and biomarker variables as dependent factors found that loneliness was associated with higher levels of cortisol, F(1, 37) = 4.91, p = .04, η = .11, and lower levels of estrogen, F(1, 36) = 7.29, p = .01, η = .17, but only in decompressed patients. Results highlight the possible impact of loneliness on biological stress responses and the need to intervene to reduce loneliness in patients with symptomatic CMI.
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http://dx.doi.org/10.1007/s12311-021-01251-wDOI Listing
March 2021

Micro Versus Macro Processes: How specific stress exposure impacts sleep, affect, and risk-related behavior on the path to disease in high-risk adults.

Anxiety Stress Coping 2021 07 22;34(4):381-396. Epub 2021 Feb 22.

Psychological Sciences, Kent State University, Kent, OH, USA.

Background: The stress-to-disease association has been well-accepted for some time. However, the understanding of stress exposure contributes to psychological disease progression remains unclear.

Objective: To test the real-time impact of variable stress exposure on risk-related clinical phenomena and affective disease progression in a high-risk sample of active-duty firefighters.

Methods: Participants completed weekly diaries reporting stressful event exposure, affect, sleep, and risk-related and healthy behaviors over six-months and were evaluated for lifetime and current psychiatric disease using clinical interviews before and after the sampling period.

Results: Stress exposure impacted clinical phenomena in differing ways. Major personal events and day-to-day hassles predicted health-impairing shifts in sleep and behavior that were associated with increases in symptoms and psychological distress over the 6-month period. In contrast, highly aversive incidents predicted greater adaptive behaviors that were uniquely predictive of symptom decreases over the six-month period.

Conclusion: These findings shed new light on stress-to-disease processes, demonstrating how variable stress exposure influences critical shifts in behavior and sleep, contributing to psychological adjustment of firefighters over time. These data suggest practical ways to monitor risk in high-risk samples (e.g., monitoring sleep latency) and offer avenues for further explication of disease processes in real time.
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http://dx.doi.org/10.1080/10615806.2021.1888933DOI Listing
July 2021

Correction to: Evaluating a screener to quantify PTSD risk using emergency care information: a proof of concept study.

BMC Emerg Med 2020 06 29;20(1):53. Epub 2020 Jun 29.

Department of Psychiatry, New York University School of Medicine, 1 Park Avenue, New York, NY, 10016, USA.

An amendment to this paper has been published and can be accessed via the original article.
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http://dx.doi.org/10.1186/s12873-020-00346-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7322923PMC
June 2020

Development of an international data repository and research resource: the Prospective studies of Acute Child Trauma and Recovery (PACT/R) Data Archive.

Eur J Psychotraumatol 2020 10;11(1):1729025. Epub 2020 Mar 10.

Traumatic Stress Center, Summa Health System, Akron, OH, USA.

: Studies that identify children after acute trauma and prospectively track risk/protective factors and trauma responses over time are resource-intensive; small sample sizes often limit power and generalizability. The Prospective studies of Acute Child Trauma and Recovery (PACT/R) Data Archive was created to facilitate more robust integrative cross-study data analyses. : To (a) describe creation of this research resource, including harmonization of key variables; (b) describe key study- and participant-level variables; and (c) examine retention to follow-up across studies. : For the first 30 studies in the Archive, we described study-level (design factors, retention rates) and participant-level (demographic, event, traumatic stress) variables. We used Chi square or ANOVA to examine study- and participant-level variables potentially associated with retention. : These 30 prospective studies (N per study = 50 to 568; overall N = 5499) conducted by 15 research teams in 5 countries enrolled children exposed to injury (46%), disaster (24%), violence (13%), traffic accidents (10%), or other acute events. Participants were school-age or adolescent (97%), 60% were male, and approximately half were of minority ethnicity. Using harmonized data from 22 measures, 24% reported significant traumatic stress ≥1 month post-event. Other commonly assessed outcomes included depression (19 studies), internalizing/externalizing symptoms (19), and parent mental health (19). Studies involved 2 to 5 research assessments; 80% of participants were retained for ≥2 assessments. At the study level, greater retention was associated with more planned assessments. At the participant level, adolescents, minority youth, and those of lower socioeconomic status had lower retention rates. : This project demonstrates the feasibility and value of bringing together traumatic stress research data and making it available for re-use. As an ongoing research resource, the Archive can promote 'FAIR' data practices and facilitate integrated analyses to advance understanding of child traumatic stress.
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http://dx.doi.org/10.1080/20008198.2020.1729025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7144287PMC
March 2020

Evaluating a screener to quantify PTSD risk using emergency care information: a proof of concept study.

BMC Emerg Med 2020 03 2;20(1):16. Epub 2020 Mar 2.

Department of Psychiatry, New York University School of Medicine, 1 Park Avenue, New York, NY, 10016, USA.

Background: Previous work has indicated that post-traumatic stress disorder (PTSD) symptoms, measured by the Clinician-Administered PTSD Scale (CAPS) within 60 days of trauma exposure, can reliably produce likelihood estimates of chronic PTSD among trauma survivors admitted to acute care centers. Administering the CAPS is burdensome, requires skilled professionals, and relies on symptoms that are not fully expressed upon acute care admission. Predicting chronic PTSD from peritraumatic responses, which are obtainable upon acute care admission, has yielded conflicting results, hence the rationale for a stepwise screening-and-prediction practice. This work explores the ability of peritraumatic responses to produce risk likelihood estimates of early CAPS-based PTSD symptoms indicative of chronic PTSD risk. It specifically evaluates the Peritraumatic Dissociative Experiences Questionnaire (PDEQ) as a risk-likelihood estimator.

Methods: We used individual participant data (IPD) from five acute care studies that used both the PDEQ and the CAPS (n = 647). Logistic regression calculated the probability of having CAPS scores ≥ 40 between 30 and 60 days after trauma exposure across the range of initial PDEQ scores, and evaluated the added contribution of age, sex, trauma type, and prior trauma exposure. Brier scores, area under the receiver-operating characteristic curve (AUC), and the mean slope of the calibration line evaluated the accuracy and precision of the predicted probabilities.

Results: Twenty percent of the sample had CAPS ≥ 40. PDEQ severity significantly predicted having CAPS ≥ 40 symptoms (p < 0.001). Incremental PDEQ scores produced a reliable estimator of CAPS ≥ 40 likelihood. An individual risk estimation tool incorporating PDEQ and other significant risk indicators is provided.

Conclusion: Peritraumatic reactions, measured here by the PDEQ, can reliably quantify the likelihood of acute PTSD symptoms predictive of chronic PTSD and requiring clinical attention. Using them as a screener in a stepwise chronic PTSD prediction strategy may reduce the burden of later CAPS-based assessments. Other peritraumatic metrics may perform similarly and their use requires similar validation.

Trial Registration: Jerusalem Trauma Outreach and Prevention Study (J-TOPS): NCT00146900.
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http://dx.doi.org/10.1186/s12873-020-00308-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7053081PMC
March 2020

The mediating impact of PTSD symptoms on cortisol awakening response in the context of intimate partner violence.

Biol Psychol 2020 04 24;152:107873. Epub 2020 Feb 24.

Kent State University| Kent State University, United States. Electronic address:

Multi-level modeling examined the association between cortisol awakening responses (CAR) and different PTSD symptom clusters in a sample of 158 female participants presenting with intimate partner violence-related PTSD. Results revealed that arousal over the past week and month, respectively ([β = -0.124, z = -2.33, p = .028; β = -.147, z = -2.19, p = .028]) significantly moderated the trajectory of cortisol levels, and emotional numbing symptom severity (over the past week [β = -0.122, z = -2.07, p = .076]) was found to be trending toward significance. In each case higher symptom severity was associated with flatter CAR slopes compared to those with lower symptom severity. Assessing PTSD symptom clusters in relation to cortisol may better inform future interventions compared to studies that assess PTSD globally. Our findings suggest a subtype of PTSD patients displaying higher levels of arousal may be more likely to experience alterations in HPA axis functioning.
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http://dx.doi.org/10.1016/j.biopsycho.2020.107873DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8088282PMC
April 2020

Genomic influences on self-reported childhood maltreatment.

Transl Psychiatry 2020 01 27;10(1):38. Epub 2020 Jan 27.

US Army Medical Research and Materiel Command, Fort Detrick, MD, USA.

Childhood maltreatment is highly prevalent and serves as a risk factor for mental and physical disorders. Self-reported childhood maltreatment appears heritable, but the specific genetic influences on this phenotype are largely unknown. The aims of this study were to (1) identify genetic variation associated with self-reported childhood maltreatment, (2) estimate SNP-based heritability (h), (3) assess predictive value of polygenic risk scores (PRS) for childhood maltreatment, and (4) quantify genetic overlap of childhood maltreatment with mental and physical health-related phenotypes, and condition the top hits from our analyses when such overlap is present. Genome-wide association analysis for childhood maltreatment was undertaken, using a discovery sample from the UK Biobank (UKBB) (n = 124,000) and a replication sample from the Psychiatric Genomics Consortium-posttraumatic stress disorder group (PGC-PTSD) (n = 26,290). h for childhood maltreatment and genetic correlations with mental/physical health traits were calculated using linkage disequilibrium score regression. PRS was calculated using PRSice and mtCOJO was used to perform conditional analysis. Two genome-wide significant loci associated with childhood maltreatment (rs142346759, p = 4.35 × 10, FOXP1; rs10262462, p = 3.24 × 10, FOXP2) were identified in the discovery dataset but were not replicated in PGC-PTSD. h for childhood maltreatment was ~6% and the PRS derived from the UKBB was significantly predictive of childhood maltreatment in PGC-PTSD (r = 0.0025; p = 1.8 × 10). The most significant genetic correlation of childhood maltreatment was with depressive symptoms (r = 0.70, p = 4.65 × 10), although we show evidence that our top hits may be specific to childhood maltreatment. This is the first large-scale genetic study to identify specific variants associated with self-reported childhood maltreatment. Speculatively, FOXP genes might influence externalizing traits and so be relevant to childhood maltreatment. Alternatively, these variants may be associated with a greater likelihood of reporting maltreatment. A clearer understanding of the genetic relationships of childhood maltreatment, including particular abuse subtypes, with a range of phenotypes, may ultimately be useful in in developing targeted treatment and prevention strategies.
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http://dx.doi.org/10.1038/s41398-020-0706-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7026037PMC
January 2020

Posttraumatic stress disorder symptom trajectories within the first year following emergency department admissions: pooled results from the International Consortium to predict PTSD.

Psychol Med 2021 05 3;51(7):1129-1139. Epub 2020 Feb 3.

Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.

Background: Research exploring the longitudinal course of posttraumatic stress disorder (PTSD) symptoms has documented four modal trajectories (low, remitting, high, and delayed), with proportions varying across studies. Heterogeneity could be due to differences in trauma types and patient demographic characteristics.

Methods: This analysis pooled data from six longitudinal studies of adult survivors of civilian-related injuries admitted to general hospital emergency departments (EDs) in six countries (pooled N = 3083). Each study included at least three assessments of the clinician-administered PTSD scale in the first post-trauma year. Latent class growth analysis determined the proportion of participants exhibiting various PTSD symptom trajectories within and across the datasets. Multinomial logistic regression analyses examined demographic characteristics, type of event leading to the injury, and trauma history as predictors of trajectories differentiated by their initial severity and course.

Results: Five trajectories were found across the datasets: Low (64.5%), Remitting (16.9%), Moderate (6.7%), High (6.5%), and Delayed (5.5%). Female gender, non-white race, prior interpersonal trauma, and assaultive injuries were associated with increased risk for initial PTSD reactions. Female gender and assaultive injuries were associated with risk for membership in the Delayed (v. Low) trajectory, and lower education, prior interpersonal trauma, and assaultive injuries with risk for membership in the High (v. Remitting) trajectory.

Conclusions: The results suggest that over 30% of civilian-related injury survivors admitted to EDs experience moderate-to-high levels of PTSD symptoms within the first post-trauma year, with those reporting assaultive violence at increased risk of both immediate and longer-term symptoms.
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http://dx.doi.org/10.1017/S0033291719004008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8318129PMC
May 2021

International meta-analysis of PTSD genome-wide association studies identifies sex- and ancestry-specific genetic risk loci.

Nat Commun 2019 10 8;10(1):4558. Epub 2019 Oct 8.

Durham VA Medical Center, Research, Durham, NC, USA.

The risk of posttraumatic stress disorder (PTSD) following trauma is heritable, but robust common variants have yet to be identified. In a multi-ethnic cohort including over 30,000 PTSD cases and 170,000 controls we conduct a genome-wide association study of PTSD. We demonstrate SNP-based heritability estimates of 5-20%, varying by sex. Three genome-wide significant loci are identified, 2 in European and 1 in African-ancestry analyses. Analyses stratified by sex implicate 3 additional loci in men. Along with other novel genes and non-coding RNAs, a Parkinson's disease gene involved in dopamine regulation, PARK2, is associated with PTSD. Finally, we demonstrate that polygenic risk for PTSD is significantly predictive of re-experiencing symptoms in the Million Veteran Program dataset, although specific loci did not replicate. These results demonstrate the role of genetic variation in the biology of risk for PTSD and highlight the necessity of conducting sex-stratified analyses and expanding GWAS beyond European ancestry populations.
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http://dx.doi.org/10.1038/s41467-019-12576-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6783435PMC
October 2019

Discrepant Responding across Measures of College Students' Sexual Victimization Experiences: Conceptual Replication and Extension.

J Sex Res 2020 May-Jun;57(5):585-596. Epub 2019 Sep 25.

Psychological Sciences, Kent State University.

Sexual violence victimization affects approximately 1 in 5 college women and 1 in 6 college men; however, rates of sexual victimization vary widely, in part due to measurement issues. The present study is the first to compare the Sexual Experiences Survey-Short Form Victimization (SES-SFV) to a measure of sexual victimization designed to capture gender differences, the Post-Refusal Sexual Persistence Scale-Victimization (PRSPS-V). Prior research has compared the perpetration versions of these questionnaires and found large discrepancies. College students (N = 673: 367 women, 298 men, 8 gender minority) were surveyed. The SES-SFV identified 260 cases of sexual victimization whereas the PRSPS-V identified 330 cases; this discrepancy was largest for men. While percent agreement between the two measures ranged from 79.9-92.0%, kappa estimates indicated that agreement was in the weak to moderate range. Kappa estimates tended to be poorer for men than women. These results highlight poor precision in the measurement of sexual violence victimization, even when using well-established measures. The PRSPS-V identified more cases and may be less gender biased. We discuss how differences in questionnaire structure, item structure, and operationalization of consent may account for discordance between the SES-SFV and PRSPS-V even when controlling for item content.
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http://dx.doi.org/10.1080/00224499.2019.1669135DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7093225PMC
July 2021

Effect of smoke exposure on young adults' sleep quality.

Nurs Health Sci 2020 Mar 19;22(1):57-63. Epub 2019 Aug 19.

Department of Psychology, Kent State University, Kent, Ohio, USA.

In this study, we aimed to examine the relationship between active smoking and environmental tobacco smoke exposure on sleep-quality complaints. In total, 1023 young adult participants completed online surveys. Based on these surveys, participants were classified into three groups according to their level of smoke exposure (low, moderate, high). An analysis of covariance revealed that, after controlling for sex, participants with high and moderate smoke exposure reported more sleep complaints than those with low exposure. Among non-smokers, hierarchical linear regression indicated that environmental tobacco smoke exposure was positively associated with sleep complaints. Improved understanding of modifiable risk factors for young adults' poor sleep quality, such as smoke exposure, could enable lifestyle changes that might lay the foundation for improved health at later life stages.
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http://dx.doi.org/10.1111/nhs.12644DOI Listing
March 2020

The Frequency of Sexual Perpetration in College Men: A Systematic Review of Reported Prevalence Rates From 2000 to 2017.

Trauma Violence Abuse 2021 07 11;22(3):481-495. Epub 2019 Jul 11.

Department of Psychological Sciences, Kent State University, Kent, OH, USA.

Background: The prevalence of sexual perpetration in college men is unknown. Prior reviews of sexual violence prevalence rates have produced wide-ranging estimates, likely due to wide variation in measurement strategies.

Objectives: This article systematically reviewed research findings (from 2000 to 2017) regarding prevalence rates of sexual perpetration in college men and measurement strategies. Data Sources: PsycINFO and Web of Science databases. Eligibility Criteria: Empirical reports published between 2000 and 2017 that included male participants, available in English, and reported lifetime prevalence findings in Canadian or American college students. Participants: Data from 78 independent samples including 25,524 college men.

Results: The average prevalence rate of any sexual perpetration was 29.3% ( = 16.8), and the average rate of rape was 6.5% ( = 6.3). Studies that used non-Sexual Experiences Survey (SES)-based questionnaires recorded higher prevalence rates (41.5%) than SES-using studies (26.2%). At least 16 different sexual perpetration questionnaires were identified. Modifying standardized questionnaires was extremely common; this was reported in over half of the studies. Studies using modified standardized questionnaires found higher prevalence rates of sexual perpetration than studies using nonmodified standardized questionnaires.

Limitations: This report focused exclusively on college men in the United States and Canada.

Conclusions And Implications: On average, 29% of college males report engaging in behaviors defined as sexual perpetration; however, there was a strong influence of measurement strategy on reported rates.
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http://dx.doi.org/10.1177/1524838019860619DOI Listing
July 2021

An examination of pain, disability, and the psychological correlates of Chiari Malformation pre- and post-surgical correction.

Disabil Health J 2019 10 21;12(4):649-656. Epub 2019 May 21.

Kent State University, Department of Psychological Sciences, USA; Northeastern Ohio Medical University (NEOMED), Department of Psychiatry, USA. Electronic address:

Background: 50% of patients with Chiari Malformation (CM) report a history of depression; however, rates of other psychological symptoms are unknown. Further, it is unclear whether surgical correction impacts pain, disability, and psychological symptoms.

Objective: /Hypothesis: We examined rates of symptoms in a nationwide sample of CM patients who had (n = 639) and had not (n = 551) undergone surgical correction. We hypothesized lower symptom severity in the latter group.

Methods: Participants completed assessments and submitted pre-surgical MRI scans online (n = 286). Informed by the Fear-Avoidance Model of pain, we controlled for psychological symptoms when assessing pain/disability, and pain/disability when assessing psychological symptoms.

Results: Overall, high rates of depression (44% moderate-severe) and anxiety (60% moderate-severe) were reported. Groups (surgery vs. no-surgery) did not differ in the proportion of patients meeting cutoff scores for current disability; however, the no-surgery group was more likely to meet cutoffs for anxiety (χ2 = 11.26, p < .05), stress (χ2 = 14.63, p < .01) and health anxiety (χ2 = 4.63, p < .05). The surgery group reported lower levels of continuous affective pain F(1, 1065) = 10.28, p < .001), anxiety F(1,1026) = 4.96, p < .05) and stress F(1, 978) = 5.67, p < .05) although effect sizes were small (ηs ranging from 0.010 to 0.006, Cohen's D ranging from 0.17 to 0.25).

Conclusion: CM patients experience high rates of psychological symptomatology regardless of surgical status, suggesting that all CM patients may benefit from evidence-based interventions to address anxiety and depression.
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http://dx.doi.org/10.1016/j.dhjo.2019.05.004DOI Listing
October 2019

Improving our understanding of the relationship between emotional abuse and substance use disorders: the mediating roles of negative urgency and posttraumatic stress disorder.

Subst Use Misuse 2019 29;54(9):1569-1579. Epub 2019 Apr 29.

a Department of Psychological Sciences , Kent State University , Kent , OH , USA.

: Emotional abuse is associated with an increased risk for substance use disorders (SUDs) as well as with negative urgency and posttraumatic stress disorder (PTSD) following a subsequent trauma. Both negative urgency and PTSD are key contributors to the relationship between emotional abuse and SUDs when examined separately. A comprehensive model including both factors can inform models of PTSD-SUD comorbidity. Furthermore, the comparison of these mechanistic roles in emotional versus other types of abuse can shed light on the specificity of these effects. : The present study tested whether negative urgency and PTSD symptom severity serially mediated the relationship between emotional abuse and substance use across two separate samples. : Participants were recruited from a detoxification center and completed a battery of surveys examining abuse history, PTSD symptom severity, and impulsivity measures including negative urgency and substance use history during the last 3 months. The samples consisted of predominantly (59% and 62%) males with an average age of 35 (age range: 18-65). The majority of participants (90% and 93%) were Caucasian. : Study 1 ( = 368) and Study 2 ( = 274) both found that negative urgency and PTSD symptom severity serially mediated the relationship between emotional abuse and substance use. When comparing indirect effects, both contributed equally. : These findings suggest that negative urgency and PTSD symptom severity together account more for the link between emotional abuse and SUDs than either alone and argue for the inclusion of negative urgency in models of PTSD-SUD comorbidity.
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http://dx.doi.org/10.1080/10826084.2019.1594905DOI Listing
March 2020

Are There Age Differences in Consolidated Episodic Memory?

Exp Aging Res 2019 Mar-Apr;45(2):97-119. Epub 2019 Mar 8.

d Department of Psychological Sciences , Kent State University , Kent , USA.

Background/Study Context: While most aging research on memory uses a retention interval of one hour or less, episodic consolidation takes longer (e.g., 6-24 hours for synaptic consolidation). In three experiments, we examined age differences in recall followed by recognition in which the retention interval was varied in younger and older adults.

Methods: In Experiment 1 (n = 24 for both age groups), zero-, 1- and 24-hour retention intervals were used for recall for all participants, and a 24-hour retention interval was used for recognition. In Experiment 2 (n = 24 for both age groups), just a 24-hour retention interval was used. In Experiment 3 (n = 20 for both age groups), a within-subjects design was used in which participants recalled one word list after one hour and again after 24 hours, and recalled another word list just after 24 hours (with recognition for both conditions after the 24-hour recall).

Results: In Experiment 1, older adults recalled fewer words at both the 1- and 24-hour retention intervals, but the magnitude of the age difference did not differ. In Experiment 2 (just 24-hour retention interval), there were no age differences in recall. In Experiment 3, in the two-recall condition, older adults showed lower recall at both 1-hour and 24-hour retention intervals (but the magnitude of the age difference remained constant across retention interval). In the single-recall just 24-hour retention condition, there were no age differences. There were no age differences in recognition in any of the three experiments.

Conclusion: These results suggest that recall declines for a 24-hour retention interval relative to a zero or one-hour retention interval (Experiments 1 and 3) for both age groups. However, when the first recall attempt occurs after a 24-hour retention interval, there are no age differences. These replicated results suggest that older adults do not benefit as much as younger adults from pre-consolidated rehearsal, but that rehearsal-based age differences do not increase in magnitude from the last rehearsal to memory consolidation. Furthermore, (along with), the present results indicate that there are no age differences in recall when the first recall attempt occurs after a long retention interval - when memory consolidation is likely to have occurred before the first retrieval attempt.
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http://dx.doi.org/10.1080/0361073X.2019.1586104DOI Listing
May 2019

Predictors of Assertive and Nonassertive Styles of Self-Defense Behavior During a Lab-Based Sexual Assault Scenario.

Violence Against Women 2020 01 25;26(1):46-65. Epub 2019 Feb 25.

Kent State University, OH, USA.

The current study examined how psychological factors influence hypothetical behavioral responses to threat (BRTT). College women ( = 113) with a history of sexual victimization completed a standardized lab-based self-defense scenario. Interpersonal skills, coping style, and assertive and nonassertive BRTT during a prior assault predicted assertive BRTT during the task. The use of nonassertive BRTT during past assaults no longer predicted assertive BRTT during the task when accounting for rape acknowledgment. Findings regarding rape acknowledgment demonstrate the complexity of recovery from sexual assault. Our results highlight interpersonal skills as an intervention target for innovative sexual assault risk reduction interventions.
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http://dx.doi.org/10.1177/1077801219828542DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8328472PMC
January 2020

Clinical implications of the proposed ICD-11 PTSD diagnostic criteria.

Psychol Med 2019 02 14;49(3):483-490. Epub 2018 May 14.

Department of Psychiatry,New York University School of Medicine,1 Park Avenue, New York, NY 10016,USA.

Background: Projected changes to post-traumatic stress disorder (PTSD) diagnostic criteria in the upcoming International Classification of Diseases (ICD)-11 may affect the prevalence and severity of identified cases. This study examined differences in rates, severity, and overlap of diagnoses using ICD-10 and ICD-11 PTSD diagnostic criteria during consecutive assessments of recent survivors of traumatic events.

Methods: The study sample comprised 3863 survivors of traumatic events, evaluated in 11 longitudinal studies of PTSD. ICD-10 and ICD-11 diagnostic rules were applied to the Clinician-Administered PTSD Scale (CAPS) to derive ICD-10 and ICD-11 diagnoses at different time intervals between trauma occurrence and 15 months.

Results: The ICD-11 criteria identified fewer cases than the ICD-10 across assessment intervals (range -47.09% to -57.14%). Over 97% of ICD-11 PTSD cases met concurrent ICD-10 PTSD criteria. PTSD symptom severity of individuals identified by the ICD-11 criteria (CAPS total scores) was 31.38-36.49% higher than those identified by ICD-10 criteria alone. The latter, however, had CAPS scores indicative of moderate PTSD. ICD-11 was associated with similar or higher rates of comorbid mood and anxiety disorders. Individuals identified by either ICD-10 or ICD-11 shortly after traumatic events had similar longitudinal course.

Conclusions: This study indicates that significantly fewer individuals would be diagnosed with PTSD using the proposed ICD-11 criteria. Though ICD-11 criteria identify more severe cases, those meeting ICD-10 but not ICD-11 criteria remain in the moderate range of PTSD symptoms. Use of ICD-11 criteria will have critical implications for case identification in clinical practice, national reporting, and research.
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http://dx.doi.org/10.1017/S0033291718001101DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6331687PMC
February 2019

Gender and age interact to predict the development of posttraumatic stress disorder symptoms following a motor vehicle accident.

Psychol Trauma 2019 Mar 15;11(3):328-336. Epub 2018 Feb 15.

Department of Psychological Sciences, Kent State University.

Objective: Women have a greater overall risk of developing posttraumatic stress disorder (PTSD) than men after exposure to trauma. In addition to gender, other sociodemographic factors have been identified as risk factors for PTSD; however, research has typically examined these factors separately. Age has been found to contribute to the development of psychiatric disorders, and both linear and curvilinear relationships have been reported between age and risk of developing PTSD. Recent research has suggested that this relationship may vary depending on gender.

Method: We performed a secondary analysis of data from a prospective study of 287 (164 men, 123 women) motor vehicle accident (MVA) patients (aged 18-81) who completed clinical interviews 6 weeks, 6 months, and/or 1 year after an MVA.

Results: Overall, women developed more severe PTSD symptoms than men; however, gender differences were small in the young (18-24 years) and the old (55 and older) groups. In women, age was not associated with PTSD symptoms at 6 weeks and 6 months; however, age was curvilinearly associated with PTSD severity at 1-year post-MVA such that middle-aged women reported greater symptom severity than younger and older women. Prior trauma exposure and social support mediated this relationship. In men, PTSD severity was not associated with age, but was related to income and social support.

Conclusions: These findings highlight age-based subgroups of women at elevated risk for PTSD following a traumatic injury and suggest that psychosocial intervention with middle-aged women following trauma exposure may help reduce the risk of persistent PTSD symptoms. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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http://dx.doi.org/10.1037/tra0000366DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7006741PMC
March 2019

Patterns of co-occurring addictions, posttraumatic stress disorder, and major depressive disorder in detoxification treatment seekers: Implications for improving detoxification treatment outcomes.

J Subst Abuse Treat 2018 03 19;86:45-51. Epub 2017 Dec 19.

Kent State University, Department of Psychological Sciences, Kent, OH, USA; Northeastern Ohio Medical University, Rootstown, OH, USA. Electronic address:

Background And Objectives: Poly-substance use and psychiatric comorbidity are common among individuals receiving substance detoxification services. Posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) are the most common co-occurring psychiatric disorders with substance use disorder (SUD). Current treatment favors a one-size-fits-all approach to treating addiction focusing on one substance or one comorbidity. Research examining patterns of substance use and comorbidities can inform efforts to effectively identify and differentially treat individuals with co-occurring conditions.

Methods: Using latent class analysis, the current study identified four patterns of PTSD, MDD, and substance use among 375 addiction treatment seekers receiving medically supervised detoxification.

Results: The four identified classes were: 1) a PTSD-MDD-Poly SUD class characterized by PTSD and MDD occurring in the context of opioid, cannabis, and tobacco use disorders; 2) an MDD-Poly SUD class characterized by MDD and alcohol, opioid, tobacco, and cannabis use disorders; 3) an alcohol-tobacco class characterized by alcohol and tobacco use disorders; and 4) an opioid-tobacco use disorder class characterized by opioid and tobacco use disorders. The observed classes differed on gender and clinical characteristics including addiction severity, trauma history, and PTSD/MDD symptom severity.

Discussion And Conclusions: The observed classes likely require differing treatment approaches. For example, people in the PTSD-MDD-Poly SUD class would likely benefit from treatment approaches targeting anxiety sensitivity and distress tolerance, while the opioid-tobacco class would benefit from treatments that incorporate motivational interviewing. Appropriate matching of treatment to class could optimize treatment outcomes for polysubstance and comorbid psychiatric treatment seekers. These findings also underscore the importance of well-developed referral networks to optimize outpatient psychotherapy for detoxification treatment-seekers to enhance long-term recovery, particularly those that include transdiagnostic treatment components.
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http://dx.doi.org/10.1016/j.jsat.2017.12.009DOI Listing
March 2018

Posttraumatic Stress in Children After Injury: The Role of Acute Pain and Opioid Medication Use.

Pediatr Emerg Care 2020 Oct;36(10):e549-e557

Department of Pediatrics, Kentucky Children's Hospital; Department of Pediatrics, University of Kentucky, Lexington, KY.

Objectives: After injury, many children experience posttraumatic stress symptoms (PTSS) that negatively impact recovery. Acute pain and PTSS share neurobiological pathways, and acute dosage of morphine has been linked to reduced PTSS in naturalistic studies. However, the complex interactions between pain, morphine and other opioid use, and PTSS have yet to be investigated in robust pediatric samples.This prospective, longitudinal study examined relationships between acute pain, opioid medications, and PTSS after pediatric injury.

Methods: Ninety-six children aged 8 to 13 years (mean = 10.60, SD = 1.71), hospitalized for unintentional injury, completed assessments at baseline (T1) and 12 weeks (T2) later. Pain ratings and opioid administration data were obtained via chart review.

Results: Structural equation modeling revealed that worst pain endorsed during hospitalization was positively associated with concurrent and later PTSS when controlling for evidence-based risk factors (ie, age, sex, prior trauma history, traumatic appraisals of injury event, heart rate). Neither opioid medications overall nor morphine specifically (milligram/kilogram/day) administered during hospitalization mediated the relationship between pain and T2 PTSS.

Conclusions: Pain during hospitalization may increase susceptibility for persistent PTSS above and beyond the influence of other empirical risk factors. Findings suggest that pain assessment may be a useful addition to pediatric PTSS screening tools and highlight the need for additional research on pharmacological secondary prevention approaches. Given that inadequate pain control and persistent PTSS each hinder recovery and long-term functioning, better understanding of interactions between acute pain and PTSS after injury is essential for improving screening, prevention, and early intervention efforts.
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http://dx.doi.org/10.1097/PEC.0000000000001404DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6047932PMC
October 2020

The Role of Negative Affect on Headache-Related Disability Following Traumatic Physical Injury.

Headache 2018 Mar 28;58(3):381-398. Epub 2017 Nov 28.

Department of Psychological Sciences, Kent State University, Kent, OH, USA.

Objective: Acute postinjury negative affect (NA) may contribute to headache pain following physical injury. Early psychiatric-headache comorbidity conveys increased vulnerability to chronic headache-related disability and impairment. Yet, it is unknown whether NA is involved in the transition to chronic headache related-disability after injury. This prospective observational study examined the role of acute postinjury NA on subacute and chronic headache-related disability above and beyond nonpsychiatric factors.

Methods: Eighty adult survivors of single-incident traumatic physical injury were assessed for negative affect (NA): a composite of depression and anxiety symptoms, and symptoms of posttraumatic stress disorder (PTSS) during the acute 2-week postinjury phase. NA was examined as the primary predictor of subacute (6-week) and chronic (3-month) headache-related disability; secondary analyses examined whether the individual NA components differentially impacted the outcomes.

Results: Hierarchical linear regression confirmed NA as a unique predictor of subacute (Cohen's f   = 0.130; P = .005) and chronic headache related-disability (Cohen's f   = 0.160; P = .004) beyond demographic and injury-related factors (sex, prior headaches, and closed head injury). Upon further analysis, PTSS uniquely predicted greater subacute (Cohen's f   = 0.105; P = .012) and chronic headache-related disability (Cohen's f   = 0.103; P = .022) above and beyond demographic and injury-related factors, depression, and anxiety. Avoidance was a robust predictor of subacute headache impairment (explaining 15% of the variance) and hyperarousal was a robust predictor of chronic headache impairment (10% of the variance).

Conclusion: Although NA consistently predicted headache-related disability, PTSS alone was a unique predictor above and beyond nonpsychiatric factors, depression, and anxiety. These results are suggestive that early treatment of acute postinjury PTSS may correlate with reductions in disability and negative physical health sequelae associated with PTSS and chronic headache.
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http://dx.doi.org/10.1111/head.13233DOI Listing
March 2018

Parental Factors Associated with Child Post-traumatic Stress Following Injury: A Consideration of Intervention Targets.

Front Psychol 2017 22;8:1412. Epub 2017 Aug 22.

Department of Psychological Sciences, Kent State University, KentOH, United States.

Post-traumatic stress disorder (PTSD) symptoms are relatively common following pediatric traumatic injury and are related to poor long-term child outcomes. However, due to concerns regarding the efficacy of early child preventive interventions, and difficulty intervening with injured and medicated children soon after the event, it is not feasible to provide early psychological interventions to children exposed to traumatic injury. Parental PTSD symptoms and reactions to the child's traumatic injury impact child outcomes and provide potential targets for early intervention to reduce child symptom development without involving the child. The authors conducted a review of the literature using Psycinfo and Pubmed research databases (publication years = 1990-2017) and identified 65 published studies relevant to the topic of the review. The present review considers parent factors [parenting styles, parental post-traumatic pathology (PTS), adaptive and maladaptive coping strategies, and communication regarding the traumatic injury] and their impact on child PTS. We focus specifically on factors amenable to intervention. We further review moderators of these relationships (e.g., child age and gender, parent gender) and conclude that it is unlikely that a one-size-fits-all approach to treatment will be successful. Rather, it is necessary to consider the age and gender of parent child dyads in designing and providing targeted interventions to families following the traumatic injury of a child.
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http://dx.doi.org/10.3389/fpsyg.2017.01412DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5572291PMC
August 2017

Age moderates the relationship between source of social support and mental health in racial minority lesbian, gay, and bisexual youth.

J Health Psychol 2019 06 11;24(7):888-897. Epub 2017 Jan 11.

1 Kent State University, USA.

We examined the relationship between source of social support and mental health (and the moderating impact of age) in 64 low socioeconomic status, racial minority lesbian, gay, and bisexual adolescents/young adults. Social support from family ( β = -.302, p = .03; β = -.364, p = .008), but not friends or significant others, was independently related to posttraumatic stress disorder and depression symptoms, respectively. Family social support was associated with lower posttraumatic stress disorder and depression symptoms in participants aged 16-19 years, while friend social support was associated with lower symptoms for participants aged over 20 years. Friend social support was also associated with lower posttraumatic stress disorder symptoms in participants aged 16-17 years. Interventions should target age-appropriate sources of social support.
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http://dx.doi.org/10.1177/1359105316686667DOI Listing
June 2019

Self-Regulation Shift Theory: A Dynamic Systems Approach to Traumatic Stress.

J Trauma Stress 2017 08 25;30(4):333-342. Epub 2017 Jul 25.

Department of Psychological Sciences, Kent State University, Kent, Ohio, USA.

Self-regulation shift theory (SRST) is a threshold theory explaining self-regulation following trauma that utilizes nonlinear dynamics to capture systemic shifts in trauma adaptation. Cusp catastrophe modeling tests nonlinear changes in an outcome (e.g., posttraumatic distress) based on an identified bifurcation factor under specific conditions (i.e., asymmetry variables). We evaluated two cusp models in a motor vehicle accident (MVA) database and then confirmed findings within a similar dataset. Based on SRST, we tested coping self-efficacy (CSE) as the bifurcation factor and a set of asymmetry controlling variables. Results demonstrated significant cusp models with CSE as a consistent bifurcation factor in all models. When participants reported lower peritraumatic dissociation, early lower CSE was a significant bifurcation factor for 3-month trauma symptoms in Sample 1, R = .18. The cusp model for changes in symptoms from 30 days to 3 months showed CSE as a significant bifurcation variable with higher levels of avoidant coping (R = .27). In a separate sample, early lower CSE was again a significant bifurcation variable with lower injury severity (R = .52). Results support the importance of self-regulatory appraisals in nonlinear shifts in posttraumatic stress symptoms 3 months post-MVA. Theoretical and practical implications are discussed.
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http://dx.doi.org/10.1002/jts.22208DOI Listing
August 2017

An initial application of a biopsychosocial framework to predict posttraumatic stress following pediatric injury.

Health Psychol 2017 08 26;36(8):787-796. Epub 2017 Jun 26.

Division of Oncology, The Children's Hospital of Philadelphia.

Objective: Each year millions of children suffer from unintentional injuries that result in poor emotional and physical health. This study examined selected biopsychosocial factors (i.e., child heart rate, peritrauma appraisals, early coping, trauma history) to elucidate their roles in promoting emotional recovery following injury. The study evaluated specific hypotheses that threat appraisals (global and trauma-specific) and coping would predict subsequent posttraumatic stress symptoms (PTSS), that coping would mediate the association between early and later PTSS, and that heart rate would predict PTSS and appraisals would mediate this association.

Method: Participants were 96 children hospitalized for injury and assessed at 3 time points: T1 (within 2 weeks of injury), T2 (6-week follow-up), and T3 (12-week follow-up). Participants completed measures of trauma history and appraisals at T1, coping at T2, and PTSS at T1, T2, and T3. Heart rate was abstracted from medical records. Structural equation modeling was employed to evaluate study hypotheses.

Results: Heart rate was not associated with PTSS or appraisals. Models including trauma history, appraisals, coping, and PTSS were constructed to test other study hypotheses and fit the data well. T1 global and trauma-specific threat appraisals were associated with T1 PTSS; T2 avoidant coping was a significant mediator of the relation between T1 and T3 PTSS.

Conclusion: Findings confirm a role for appraisals and coping in the development of PTSS over the weeks following pediatric injury. Early appraisals and avoidant coping may be appropriate targets for prevention and early intervention. Future researchers should further explicate the utility of a biopsychosocial framework in predicting PTSS. (PsycINFO Database Record
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http://dx.doi.org/10.1037/hea0000508DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5673123PMC
August 2017

Oxytocin and Other Pharmacologic Preventive Interventions for Posttraumatic Stress Disorder: Not a One-Size-Fits-All Approach.

Biol Psychiatry 2017 06;81(12):977-978

Department of Psychological Sciences, Kent State University, Kent; Department of Psychiatry, Northeastern Ohio Medical University, Rootstown, Ohio. Electronic address:

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http://dx.doi.org/10.1016/j.biopsych.2017.04.001DOI Listing
June 2017

A multi-level modeling approach examining PTSD symptom reduction during prolonged exposure therapy: moderating effects of number of trauma types experienced, having an HIV-related index trauma, and years since HIV diagnosis among HIV-positive adults.

AIDS Care 2017 11 7;29(11):1391-1398. Epub 2017 Mar 7.

a Department of Psychology , Kent State University , Kent , USA.

People living with HIV (PLWH) have extensive interpersonal trauma histories and higher rates of posttraumatic stress disorder (PTSD) than the general population. Prolonged exposure (PE) therapy is efficacious in reducing PTSD across a variety of trauma samples; however, research has not examined factors that influence how PTSD symptoms change during PE for PLWH. Using multi-level modeling, we examined the potential moderating effect of number of previous trauma types experienced, whether the index trauma was HIV-related or not, and years since HIV diagnosis on PTSD symptom reduction during a 10-session PE protocol in a sample of 51 PLWH. In general, PTSD symptoms decreased linearly throughout the PE sessions. Experiencing more previous types of traumatic events was associated with a slower rate of PTSD symptom change. In addition, LOCF analyses found that participants with a non-HIV-related versus HIV-related index trauma had a slower rate of change for PTSD symptoms over the course of PE. However, analyses of raw data decreased this finding to marginal. Years since HIV diagnosis did not impact PTSD symptom change. These results provide a better understanding of how to tailor PE to individual clients and aid clinicians in approximating the rate of symptom alleviation. Specifically, these findings underscore the importance of accounting for trauma history and index trauma type when implementing a treatment plan for PTSD in PLWH.
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http://dx.doi.org/10.1080/09540121.2017.1300625DOI Listing
November 2017

The association between daily PTSD symptom severity and alcohol-related outcomes in recent traumatic injury victims.

Psychol Addict Behav 2017 05 6;31(3):326-335. Epub 2017 Mar 6.

Department of Psychological Sciences, Kent State University.

The self-medication hypothesis proposes that individuals experiencing posttraumatic stress disorder (PTSD) symptoms may use alcohol (or other substances) to self-medicate distress, while the mutual maintenance hypothesis proposes that alcohol use also exacerbates or maintains distress. Existing research largely supports the self-medication hypothesis. However, findings are often based upon retrospective reporting of problems and assessment of symptoms anchored to a trauma occurring in the remote past. To improve on these retrospective designs, the current study examined the relationship between daily PTSD symptom severity and alcohol-related outcomes during the early phase of recovery following a traumatic physical injury. Specifically, 36 injury victims reported on PTSD symptom severity, alcohol craving, alcohol consumption, and negative drinking consequences thrice daily (morning, afternoon, night) over 7 days beginning 6 weeks postinjury. Results indicated relationships between PTSD symptom severity and alcohol craving/negative consequences when these experiences were assessed concurrently within the same signal (particularly during the nighttime assessments). Prospective models found that nighttime PTSD symptom severity was related to negative drinking consequences occurring the following morning, even after controlling for consumption level, suggesting a more general behavioral regulation problem. Results were less supportive of the mutual maintenance hypothesis. Collectively, these results suggest that health interventions targeting PTSD symptom severity in recent injury victims-particularly when delivered at night-may be able to prevent problematic alcohol use. (PsycINFO Database Record
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http://dx.doi.org/10.1037/adb0000262DOI Listing
May 2017
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