Adherence to treatment recommendations following medical care for pediatric conditions is critically important for promoting optimal physical and psychological well-being. While it has been a focus of many studies across pediatric chronic illness populations, there is a dearth of research examining adherence following pediatric unintentional injury. Empirical evidence from studies with pediatric chronic illness samples indicates that youth experience a number of barriers to adherence to medical recommendations. Adherence is especially difficult for adolescents due to the unique challenges of this developmental period. A mixed methods research approach was utilized to gain a holistic understanding of potential psychological barriers to adherence following adolescent injury. Quantitative analyses examined the potential predictive roles of adolescent psychological [i.e., posttraumatic stress (PTSD), depression, quality of life] and relational (i.e., parent PTSD and depression) factors on adherence. Results of analyses were insignificant; thus, qualitative data was collected to deepen the understanding of barriers to adherence. Findings from qualitative data analyses suggested that a number of barriers to adherence to treatment recommendations exist, including: concern of pain medication addiction, competing activities, treatment side effects, health status, desire for autonomy, and symptoms of depression. Results of qualitative analyses also revealed the presence of additional factors that could facilitate adherence to treatment recommendations. Taking into consideration findings from both quantitative and qualitative analyses, adherence may be best conceptualized as a result of a dynamic decision-making process influenced by numerous interacting factors. This study is the first to examine barriers to adherence among adolescents following unintentional injury and provides an initial roadmap for understanding the mechanisms involved in this complex process. / Ph. D.

This study evaluated a revised version of the Stress-Related Growth Scale (SRGS-R). The SRGS-R has two major differences from the Stress-Related Growth Scale (SRGS). It uses neutral wording of items instead of the original positively worded items, and it uses positive and negative scaling choices. This study included participants (N = 764) recruited through Amazon MTurk. There were three versions of the SRGS-R tested - the SRGS with neutral wording of items only (SRGS-R-N), the SRGS with positive and negative scaling only (SRGS-R-S), and the SRGS-R, with both changes. We randomly assigned participants to complete one of four PTG measures - the SRGS-R-N, SRGS-R-S, SRGS-R, or the Posttraumatic Growth Inventory (PTGI). The PTGI elicited the largest levels of reported PTG, while the SRGS-R elicited the smallest levels. The two modified versions displayed scores between the SRGS-R and the PTGI in the small and moderate growth groups. In the current study the SRGS-R was negatively related to PTSD symptoms, depression, anxiety (negative, but not statistically significant), global distress (negative, but not statistically significant), and avoidance-focused coping (negative, but not statistically significant), and positively related to positive well-being, quality of life, problem-focused coping, and emotion-focused coping. In comparison, the PTGI was unrelated to depression, anxiety, and global distress, and positively related to PTSD symptoms, positive well-being, quality of life, and all three coping styles. These findings provide further evidence that the SRGS-R is an improvement over the PTGI in measuring actual growth, while limiting illusory growth. We found the combination of these changes yields the greatest improvements in measurement. By improving the measurement of PTG, we can reduce the variation in reported PTG following traumatic events found throughout the literature. This will allow researchers and clinicians to better identify which factors contribute to growth following traumatic events, and aid them in designing treatments to encourage actual growth following traumas.

Domestic violence is a pervasive problem. Approximately one quarter of all women will be assaulted by a partner in their lifetime. It is difficult to predict how resilient a woman will be after being abused, and how severe the negative consequences may be. The present study sought to identify variables that are the strongest predictors of traumatic symptoms after experiencing domestic violence, and also test social support as a moderator of these trauma symptoms. One hundred and twenty two women incarcerated in a local south Florida county jail participated in the study. They were administered the BWSQ-3, DAPS, and AAS-R. Types of abuse experienced, number of abusive relationships, time in abusive relationship, and severity of injuries were all found to be significant predictors of clinically significant trauma symptoms; types of abuse experienced and severity of injuries contributed over and above the other variables. It was observed that approximately 71% of women identified as having a secure attachment style sought help outside the relationship for the abuse. It was also determined that women with a secure attachment style significantly differed from those with a preoccupied or fearful attachment style in the rates at which they sought help. The final analysis indicated social support effectively moderates the resulting trauma symptoms after being abused; women who have experienced mild to moderate abuse, who also have adequate social support, had lower rates of clinically significant trauma symptoms. The present findings are important for guiding treatment and the development and implementation of more effective interventions.

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Thesis advisor: Margaret Lombe / Over the past several decades trauma research has expanded to recognize the heterogeneity in post-exposure reactions. Posttraumatic stress disorder, the most commonly researched mental health outcome associated with trauma, does not develop in all trauma survivors. Rather, more common trajectories of adaptation following a trauma include normative health adaptation, resilience, and posttraumatic growth. The aims of the current study were to: (1) describe and characterize post-combat adaptation profiles in a sample of Israeli male military veterans (N = 448) based on the combination of posttraumatic distress symptoms, types of coping strategies, and level of posttraumatic growth; (2) test the utility of latent class membership on predicting the quality of posttraumatic growth (i.e. constructive growth); and (3) explore the protective factors (i.e. social support and adaptive coping) that promote constructive posttraumatic growth for each profile of post-combat adaptation. The current study used latent profile mixture modeling to identify profiles of post-combat adaptation, Heckman-probit regression models, and logistic regression analysis. Demographic controls, combat related variables, type of coping strategies utilized, and baseline reports of social support were not significant predictors of constructive growth in either the resilient or struggling latent classes. However, for those in the struggling subset of the sample, reported improvement in perceived social support during the intervention increased the odds of reaching constructive growth. This relationship did not hold for the resilient subset of the sample. The study extends existing literature and theory by proposing a more complex and nuanced examination of posttrauma adaption, and specifies conditions under which protective factors may influence positive adaptation outcomes such as constructive growth. These findings highlight the importance of tailored clinical interventions that account for more complex profiles of post-combat adaptation and provide additional support for the unique effects of group intervention modalities. Further, these findings provide evidence that adaptation takes place over time and as such services should continue to be available for veterans long after combat exposure. Finally, these findings call for future research to build on existing longitudinal investigation by examining the complex temporal components of adaptation in trauma survivors. / Thesis (PhD) — Boston College, 2016. / Submitted to: Boston College. Graduate School of Social Work. / Discipline: Social Work.

Thesis advisor: Paul Kline / This three paper dissertation considers whether yoga--a popular mind-body practice combining physical postures and movement, mindfulness, and breath exercises--may be a useful component of treatment for adult trauma survivors. The first paper involves a systematic review and meta-analyses of the current evidence base for yoga in the treatment of anxiety, depression, and PTSD among trauma survivors. The second and third papers are grounded in a single, mixed-methods multi-wave data source aimed at examining yoga's contribution to recovery for adult women who have complex trauma histories (i.e., sustained and/or multiple traumatic experiences such as recurring physical or sexual abuse). The second paper is a quantitative study employing hierarchical linear and logistic regression to examine associations between yoga practice and reductions in traumatic symptomology over time. The third paper is a hermeneutic phenomenological study exploring how women with complex trauma histories experience practicing yoga and its potential role in their coping and healing processes over time. Taken together, these three papers offer insights into the complex healing needs of adult survivors suffering from the effects of traumatization, and the promising role of yoga within their recovery processes. / Thesis (PhD) — Boston College, 2014. / Submitted to: Boston College. Graduate School of Social Work. / Discipline: Social Work.

Posttraumatic stress disorder (PTSD) is a common psychiatric disorder and is associated with impairment in multiple domains. Research on the development of PTSD symptoms is often limited by the use of cross-sectional designs and retrospective reports of pre-trauma factors. The trauma film paradigm allows for the measurement of pre-trauma factors to determine which variables serve as prospective predictors of posttraumatic stress symptom development. Two factors which may predict posttraumatic stress symptom development are distress intolerance and attentional control. Research suggests distress intolerance is related to posttraumatic stress symptoms, but this relationship has only been shown cross-sectionally. Research has further shown attention control prospectively predicts posttraumatic stress symptoms. Cross-sectional research also suggests attentional control moderates the relationship between distress intolerance and posttraumatic stress symptoms. The current study used the trauma film paradigm to investigate whether attentional control moderates the relationship between distress intolerance and posttraumatic stress symptoms. The current study findings were mixed, but suggest that attentional control does not moderate the association between distress intolerance and posttraumatic stress symptoms. These results suggest distress intolerance and attentional control may not be important variables in the development of posttraumatic stress symptoms.

Historically, in many areas of research examining birth and parenthood the role of the mother often took precedence over the role of the father. This may be because, within a traditional family system, the father took the role of the provider, while the mother was responsible for child care and household. Societal and cultural changes over the past few decades have highlighted the importance and competence of fathers in less traditional roles and scientific research is currently aiming to fill the gap of knowledge pertaining to fatherhood. One field of research that has traditionally been neglected in fathers is postpartum depression (PPD), even though prevalence rates for fathers were estimated to be almost as high as for mothers. Research into the risk factors for paternal PPD has only grown substantially within the past two decades. The first part of this thesis provides a systematic review of the available evidence for psychosocial risk factors in the development of paternal PPD as examined by longitudinal research designs. Results of the review indicated that there was a general lack of high quality research, but there was some evidence for higher risk of PPD if fathers experienced disconfirmed expectations of parenting demands, low parenting efficacy, low relationship satisfaction, concerns/anxiety about the birth, disagreement about pregnancy intendedness, low prenatal life satisfaction and stress, and high role strain. The results were discussed in the context of implications for antenatal interventions for fathers. The second part of this thesis was concerned with another neglected group of fathers – fathers who were addicted to opiate drugs. While there is a large research base for the risk to children exposed to parental substance use, fathers’ views on their parenting role and the cross-generational transmission of risk of child maltreatment and substance use has only partially been examined. Using Interpretative Phenomenological Analysis with a small sample of opiate-using fathers (N = 6), it was found that fathers experienced dichotomy in their father role. Their addiction caused them to be ‘disabled’ in the ir father role, characterised by selfishness, abandonment and an inability to meet their children’s needs. In contrast, the ‘Able Father’ came to light during stable periods of prescribed opiates or abstinence, and he was an involved, hands-on parent, sensitive to the child’s needs and motivated to repair the ill-effects of being ‘disabled’ by addiction. By ‘Connecting the Dots’ with their own upbringing, fathers were motivated to be better fathers than their own fathers, but they only had limited insight into the risk the ir ‘disabled’ parenting posed for their own children. The findings suggest that harnessing fathers’ motivation to be better fathers may be a useful asset in drug treatment and parenting interventions. Interventions aimed at increasing reflective functioning may contribute to positive outcomes for substance-using parents at the same time as reducing risk to their children, but more evidence is needed.

The goal of this dissertation is to investigate the factors that increase risk for posttraumatic stress disorder (PTSD) in Latinos. Although the overall rates of psychiatric disorders in the Latino community are similar to Caucasian Americans, the risk for PTSD among Latinos is higher. This thesis discusses the general components of trauma and stress, as well as the prevalence of PTSD in various Latino subgroups. This thesis also covers a number of cultural-specific values, stressors, and help-seeking attitudes that increase the risk of PTSD among Latinos. Moreover, a culturally-responsive intervention program treating PTSD among Latinas who are victims of intimate partner violence (IPV) is proposed.

Refugee torture survivors often present with a myriad of psychological challenges, such as posttraumatic stress and depression, stemming from their exposure to torture and other pre- and post-settlement experiences (Gong-Guy and colleagues, 1991). The present study examined the moderating effect of four coping processes (i.e., family support, religious beliefs, political beliefs, and will to survive) on the relationship between cumulative torture and posttraumatic stress disorder (PTSD) among a sample of 204 (N=204) adult refugee torture survivors. Subjects completed a demographic questionnaire, the Torture Severity Scale (TSS; Kira, Lewandowski, Templin, Ramaswamy, Ozkan, Hammad, & Mohanesh, 2006), the Clinician Administered PTSD Scale (CAPS-2; Weathers, Keane, & Davidson, 2001), and the Means of Survival Scale (MOS; Kira, 2012). Twenty-three percent (N = 74) of the sample endorsed clinically significant levels of PTSD. Torture and PTSD were positively associated, indicating that greater exposure to cumulative torture is associated with greater trauma symptoms (r[2] = .18, pppppp2 = .039; F (2,323) = 7.55, p=.001. None of the interaction terms examined accounted for significant variation in PTSD symptoms. Study findings will help counseling psychologists devise the most appropriate treatment plans and strategies to treat posttraumatic stress reactions among refugee torture survivors, as well as inform future interventions developed for this vulnerable population.