Recent studies of children and adolescents who have experienced a residential, industrial, or wild fire have suggested a causal link between fire disaster and PTSD related psychological distress. Not everyone, however, is equally affected by the stress of experiencing such an event, and the role of coping in this process may be an important mediating factor. Additionally, several studies have found that girls and African Americans report more distress following disasters than do boys and Caucasians. The current study sought to investigate the roles of exposure/loss, coping efficacy, and coping strategy in mediating psychological distress in adolescents after a disaster. The current study included a representative sample of 206 9th graders from a Central Florida High School affected by severe wildfires who were assessed via self-report measures 3- and 10- months after the fires, in a latent variable path analysis to assess the fit of a model including exposure/loss, coping efficacy, coping strategy, and PTSD, depression, and anxiety scores. Moreover, acculturation level and SES were included along with gender and ethnicity in testing for the moderating role of sociodemographics, as little research has delved into the important proximal factors affecting reported racial differences, as ethnicity is better conceptualized as a distal variable that works through a variety of proximal variables to affect outcomes. Results indicated that although the assessment of the global fit of the latent variable path model revealed it to be a poor fit to the data, component fit of the model pointed to a possible mediating role of coping efficacy between exposure/loss and psychological distress, as well as coping efficacy being associated negatively with avoidant coping strategies. Likewise, post hoc regression analyses indicated an important role for exposure/loss, coping efficacy, and coping strategy as they related to PTSD symptomatology in adolescents at both Time 1 and Time 2. Finally, although relationships between the proposed variables and PTSD did not interact with gender, acculturation, SES, or ethnicity, there was a significant interaction between acculturation and ethnicity signifying that for African American youth, high acculturation levels were predictive of less PTSD symptomatology. / Ph. D.

Objective: To describe the prevalence and impact of vestibular dysfunction and nonspecific dizziness diagnoses and explore their associations with traumatic brain injury (TBI) severity, mechanism, and postconcussive comorbidities among post-9/11 veterans. Setting: Administrative medical record data from the US Departments of Defense and Veterans Affairs (VA). Participants: Post-9/11 veterans with at least 3 years of VA care. Design: Cross-sectional, retrospective, observational study. Main Measures: International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes for TBI, vestibular dysfunction, dizziness, and other commonly associated postconcussive conditions; Neurobehavioral Symptom Inventory. Results: Of the 570 248 post-9/11 veterans in this sample, 0.45% had a diagnosis of vestibular dysfunction and 2.57% had nonspecific dizziness. Those with either condition were more likely to have evidence of TBI (57.11% vs 28.51%) and reported more disruption from neurobehavioral symptoms. Blast and nonblast injuries were associated with greater symptom disruption, particularly in combination. Conclusions: There was a consistent, significant association between TBI and vestibular dysfunction or nonspecific dizziness, after controlling for sociodemographic factors, injury mechanism, and comorbid conditions. Given that most deployed post-9/11 veterans report blast and/or nonblast injuries, the need for prompt identification and management of these conditions and symptoms is clear.

Background The postpartum period represents a major transition in the lives of many women, a time when women are at increased risk for the emergence of psychopathology including depression and PTSD. The current study aimed to better understand the unique contributions of clinically significant postpartum depression, PTSD, and comorbid PTSD/depression on mother–infant bonding and observed maternal parenting behaviors (i.e., behavioral sensitivity, negative affect, positive affect) at 6 months postpartum. Methods Mothers (n=164; oversampled for history of childhood maltreatment given parent study's focus on perinatal mental health in women with trauma histories) and infants participated in 6-month home visit during which dyads engaged in interactional tasks varying in level of difficulties. Mothers also reported on their childhood abuse histories, current depression/PTSD symptoms, and bonding with the infant using standardized and validated instruments. Results Mothers with clinically significant depression had the most parenting impairment (self-report and observed). Mothers with clinically significant PTSD alone (due to interpersonal trauma that occurred predominately in childhood) showed similar interactive behaviors to those who were healthy controls or trauma-exposed but resilient (i.e., no postpartum psychopathology). Childhood maltreatment in the absence of postpartum psychopathology did not infer parenting risk. Limitations Findings are limited by (1) small cell sizes per clinical group, limiting power, (2) sample size and sample demographics prohibited examination of third variables that might also impact parenting (e.g., income, education), (3) self-report of symptoms rather than use of psychiatric interviews. Conclusions Findings show that in the context of child abuse history and/or current PTSD, clinically significant maternal depression was the most salient factor during infancy that was associated with parenting impairment at this level of analysis.

In this paper, we investigate the potential for the development of a composite score investigating population-level phenotype changes in a mouse model of traumatic brain injury. Traumatic brain injuries (TBI) are a growing concern in the United States because the number of individuals impacted by TBI and associated symptoms is increasing, leading to a growing demand for research both in the clinical and preclinical setting. However, preclinical TBI modeling is complicated by the lack of inter and intra lab consistency in the assessment of behavioral and pathologic outcomes. Indeed, it remains unclear which behavior assessments are most useful in evaluating the effects of preclinical TBI. To investigate the relative contribution of various behavior tests in the assessment of preclinical TBI, three statistical models (simple linear regression, pairwise correlation, and factor analysis) were conducted on behavioral data from the Mannix-Meehan lab at Boston Children’s Hospital in Boston, Massachusetts, U.S.A. from 2012-2018. In this paper, a composite metric was created from the computation analysis of the three statistical methods. The score revealed MWM and EPM as the most potent behavioral tests. The Open Field and Rotarod test had a small impact on the outcome, but only in one of the three statistical models assessed. Thus, to effectively analyze treatment efficiencies, injury severity and long-term impairments, MWM and EPM are the best behavioral test for a mouse model. Furthermore, this method of analysis of entire populations of mice allows for more subtle phenotypic changes resultant from injury models to be revealed, and the generalizability of this model lends to widespread use.

Scholarly articles related to the physical and emotional effects of prostate cancer treatment and survivorship are abundant. However, few researchers have explored resiliency of prostate cancer survivors through their recovery and survivorship experience. There is a gap in the literature regarding resilience through the lived experiences of prostate cancer survivors. Counselor educators could be better prepared to teach counselors to promote the resilience needs of prostate cancer survivors. The purpose of this hermeneutic phenomenological qualitative study was to explore and describe the lived experiences of prostate cancer survivors. Coding analysis of data collected from interviews of 7 participants generated 3 major themes and 30 subthemes of experiences. Themes included experiences and feelings surrounding the cancer diagnosis, descriptions of resilience, and the personal growth the participants gained from their experiences. The results of this study give voice to their challenges and offer insight into how prostate cancer survivors find meaning while adapting constructively to adversity and resilience. A clearer understanding of these experiences may promote understanding of the prostate cancer experience for men, offer insight for promoting resilience among prostate cancer survivors, and give clues to the experiences of other populations responding to cancer.

While it is commonly known that combat-related posttraumatic stress disorder (PTSD) has profound, long-term effects on soldiers, its effects on spouses of affected soldiers are less understood. Some spouses who provide care for soldiers with PTSD develop symptoms that are similar in nature. These symptoms include but are not limited to depression, anxiety, isolation, hypervigilance, and a strong startle effect. This study explored the lived experiences of 8 spouses of Army Reservists who returned from deployment in either Iraq or Afghanistan with combat-related PTSD. This study used the couple adaptation to traumatic stress model to explore the couple's response to traumatic stress. The study also includes a discussion of the history of PTSD, including changes in criteria with the revisions of the Diagnostic and Statistical Manual of Mental Disorders (DSM), including the most recent change in the latest version (DSM 5). Although secondary traumatic stress is not recognized in the DSM 5, an increase in awareness may result in a better understanding of mental health needs within the military culture. The study consisted of 8 semi-structured interviews among 8 female spouses of Army Reserve soldiers, using Colaizzi's method of data analysis. The results of this study identified psychological distress in all participants in connection with relationship changes, psychological distress, and lack of available mental health services. The results of this study may assist mental health professionals understand that the mental health needs of spouses of Reservists often differ from those of active duty spouses. This study may support social change by promoting the need for additional training for counselors who work with this population.

Compassion fatigue and work-related burnout are harmful reactions to patient situations and work environments that negatively affect nurses' well-being and ability to provide safe, effective patient care. However, research is needed to understand how reflection as a self-care response to patient situations is related to nurses' development of work burnout, compassion fatigue, and secondary traumatic stress, a type of compassion fatigue. The purpose of this correlational, cross-sectional quantitative study was to determine the relationship between hospital-based acute care nurses' levels of reflection and their levels of compassion fatigue, secondary traumatic stress, and work burnout. The study was based on Hentz and Lauterbach's model for reflective practice and Kearney, Weininger, Vachon, Harrison, and Mount's self-awareness-based model of self-care. Internet-based surveys consisting of demographic items, the Groningen Reflective Ability Scale, and the Compassion Fatigue-Short Scale were distributed to a randomly selected sample of 2,000 registered nurses in the southeastern United States. Spearman correlation, Pearson correlation, and binary linear regression analyses revealed no significant relationship between the variable of reflection and the variables of compassion fatigue, secondary traumatic stress, and work burnout among hospital-based acute care nurses. Incidental findings revealed significant positive correlations among compassion fatigue, secondary traumatic stress, and work burnout. The study findings can be used to effect positive social change and inform future research within the nursing profession by highlighting reflective nursing practice and providing awareness of the positive relationships among compassion fatigue, secondary traumatic stress, and work burnout in nurses.

Veterans with post-traumatic stress disorder (PTSD) have increased rates of overweight/obesity, higher prevalence of obesity-related medical conditions, and greater morbidity and mortality compared to their peers without PTSD. The aim of this study was to assess the impact of PTSD on weight and metabolic parameters as well as the effect of weight change on metabolic indices. In a case-control cohort, we compared PTSD patients (n=364) with those without mental health disorders (NoMH, n=1,008) at baseline (i.e., eight years prior to enrollment) and on the trajectory of changes before the enrollment in the Miami VA MOVE!® (Weight Management for Veterans) program. Multilevel modeling for change was used to investigate changes in weight and physiological markers over time. The sample consisted of 1,372 veterans (1,208 men and 164 women). Mental health status, weight and metabolic parameters were obtained from medical record. The PTSD group was significantly younger, had lower average BMI at baseline, and higher prevalence of weight-related medical conditions. Groups did not differ by gender, race/ethnicity, or Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) status. At baseline, the PTSD group had significantly lower weight, lower HDL-cholesterol, and higher values for glucose and triglycerides than the NoMH group. The PTSD group had a significantly greater slope than NoMH group for HDL-cholesterol (p¬=.011). The difference in rate of change between groups for weight, glucose, and triglycerides was not significant. The sample as a whole showed a significant increase for weight and glucose while total cholesterol, blood pressure, and triglycerides decreased over time. Despite lower weight, veterans with PTSD had greater prevalence of weight related-medical conditions while rate of change in metabolic parameters over time was comparable to NoMH peers. Exploratory analyses showed that weight had a significant negative effect on total cholesterol and blood pressure. PTSD appears to be a significant risk factor for diabetes and overall metabolic dysfunction. The lack of results with regards to the effect of weight on HDL cholesterol, triglycerides, glucose and hemoglobin A1c are not surprising given the complex relationships among weight and these metabolic indices.

Background: Uncontrolled bleeding accounts for the majority of preventable deaths in the severely injured in both the civilian and military settings. Trauma induced coagulopathy (TIC) is now widely accepted as a major contributing factor to worsening bleeding in these patients. A quarter of severe trauma patients present with coagulopathy on admission and remain a group with high morbidity and mortality. Objectives: To describe the spectrum of coagulation profiles amongst severely injured patients presenting to an urban level-one trauma centre at Groote Schuur Hospital and to correlate these with blood product requirements, morbidity and mortality. Method: This is a retrospective study of all patients with complete baseline TEG coagulation parameters collected prior to randomization in the FIRST (Fluids In Resuscitation of Severe Trauma) trial between January 2007 and December 2009. Parameters recorded for this study included patient demographics, mechanism of injury, admission vital signs, lactate, base excess, coagulation studies PT, INR, TEG parameters, volume and type of fluids administered, volume of blood products administered, length of ICU stay, and major outcomes. Injury severity was categorized according to the Injury Severity Score (ISS) and New Injury Severity Score (NISS). Results: A total of 87 patients were included in this study, with a median ISS of 20 and 57.5% had a penetrating injury mechanism. Coagulopathy was highly prevalent in this cohort, of which a majority (69%) was diagnosed with hypercoagulopathy and 24% had a hypocoagulopathy status on admission. There was no difference in age, gender and amount 9 of pre-hospital fluids administered across the three groups (normal v/s hyper v/s hypo). Median volume of blood products was higher in the hypocoagulopathy group, although not statistically significant. Overall, 30-day mortality rate was 13%, with case fatalities occurring in only coagulopathic patients; hypercoagulopathy (15%) and hypocoagulopathy (10%). Conclusion: Trauma induced coagulopathy is not an infrequent diagnosis and remains a challenging clinical entity to manage in severely injured patients resulting in increased morbidity and mortality. Determining the coagulation profile using TEG at presentation in this group of patients may guide appropriate management guidelines in order to improve outcome. Hypercoagulable patients need to be recognised amongst the TIC patients as it results in different sequelae and impacts on clinical decision in the use of antifibrinolytic agents as compared to hypocoagulopathy.

Indiana University-Purdue University Indianapolis (IUPUI) / Intimate partner violence is a problem in the United States (U.S.) military. Previous research has identified factors that increase a couple’s risk for engaging in violence. Most of these factors, such as age, alcohol, and relationship satisfaction are consistent across civilian and military samples. One factor that is unique to military samples is deployment; service members can be exposed to unique traumatic incidents while deployed which are generally unknown to most civilians. Deployments can also increase a service member’s risk for developing Post Traumatic Stress Disorder (PTSD), which can increase their risk for intimate partner violence. Previous research on the effect of deployments on intimate partner violence has produced mixed results. The purpose of this study was to analyze if deployment, total length of deployment, combat experiences from deployment, and PTSD symptoms increased risk for Air Force airmen to perpetrate intimate partner violence at a moderate or severe level of violence. Survey data from a representative sample of active duty Air Force airmen (N = 1,501) was used to conduct Chi-Square analyses and multinomial logistic regression models for perpetrated violence. Results of the study showed that deployment and combat experiences were not significant predictors of perpetrated violence. PTSD symptoms, in addition to alcohol misuse and relationship satisfaction, were significant predictors of moderate and severe perpetrated violence. In terms of practice and policy implications, the study results underscore the importance of widespread screening for these risk factors as well as the availability of interventions focused on alcohol use and relationship issues among service members. Future research could determine if PTSD symptoms moderate the relationship between combat experiences and intimate partner violence.