This qualitative research study explores what veterans living in the Appalachian region experience in receiving care for Posttraumatic Stress Disorder through personal interviews. These interviews will give insight into how veterans in Appalachia perceive their care through specific questions pertaining to healthcare for Posttraumatic Stress Disorder. A convenient sample of veterans attending the specific study site was used for this study. An email, which contained information about the background and nature of the study was used for participant recruitment of veterans. In addition, flyers with the same information were posted throughout the study site. This study will highlight specific details of veterans’ care for Posttraumatic Stress Disorder that will help to accumulate information on the care given to veterans in Appalachia. The Appalachian region is described by the Appalachian Regional Commission as "a 205,000 square mile region that follows the spine of the Appalachian Mountains from southern New York to northern Mississippi"(The Appalachian region- Appalachian Regional Commission, n.d.).

Suicide rates are higher in veterans than civilians, perhaps due to increased trauma exposure (e.g., sexual trauma, combat). However, not all veterans who experience trauma are at increased risk for suicidal behavior as some may experience an increased sense of purpose and meaning in life via posttraumatic growth (PTG). PTG, conceptualized as a positive transformation following trauma that results in improved function, may involve changes in cognitive-emotional processing, including increased feelings of connectedness and perceptions of value and contribution contributing to the well-being of others, as well as beneficial shifts in mood. The interpersonal theory of suicide posits that individuals who feel isolated (thwarted belongingness; TB), or like a burden (perceived burdensomeness; PB) are at increased risk for depression and suicidal ideation and attempts. Veterans who experience PTG after trauma may experience a beneficial shift in perceptions related to interpersonal needs (e.g., feel more connected, feel like less of a burden), with consequent benefits to mood and suicide risk. This premise has not been previously examined; therefore, we assessed the serial mediating effects of thwarted interpersonal needs (i.e., TB and PB, in separate models) and depression on the link between PTG and suicidal behavior. Participants (N=545; 70.1% male (n=382); 86.4% Caucasian (n=469), Mean Age=49.86, SD=16.78) were community-dwelling veterans, who completed the Posttraumatic Growth Inventory, Interpersonal Needs Questionnaire, Multidimensional Health Profile, and Suicide Behaviors Questionnaire-Revised. Bivariate correlations and serial mediation analyses were conducted covarying age, sex, and ethnicity. Serial mediation analyses supported hypotheses (10,000 bootstrapped samples); the total indirect effect of PTG on suicidal behaviors was significant when thwarted belongingness (IE= -.024, SE= .005, CI= -.036 to -.015) and perceived burdensomeness (IE= -.024, SE= .006, CI= -.036 to -.014), along with depression, were examined as serial mediators. Specific indirect effects of PTG on suicidal behaviors were also significant through thwarted belongingness (IE= -.015, SE= .005, CI= -.026 to -.008) in the first model and perceived burdensomeness (IE= -.016, SE= -.005, CI= -.027 to -.008) in the second model; however, there were no specific indirect effects observed through depressive symptoms in either model. Our results suggest that the relation between PTG and reduced suicidal behavior may be due to serial, adaptive shifts in cognitive-emotional processing related to interpersonal functioning and mood which, in turn, beneficially impact mood and suicide risk. Of note, there were no significant specific indirect effects with depressive symptoms. This pattern elucidates a potential mechanism between PTG and suicidal behavior, highlighting that the process of PTG does not, initially, involve a reduction of depressive symptoms but, rather, an improvement in perceptions regarding social connectedness and social self-value that has a cascading effect on mental health functioning. Our findings may have clinical implications. Cognitive reframing of traumatic events (e.g., via Cognitive Processing Therapy) and bolstering relationships and the perception of one’s value in a social network (e.g., via Interpersonal Therapy) may reduce depression and suicide risk in veterans.

Prevalence of PTSD is higher in veterans compared to the general population, with between 12 and 31% of veterans, across combat eras, developing PTSD during their lifetime, compared to 7-8% of civilians, perhaps as a result of military-related experiences (e.g., combat, sexual trauma). Such experiences contribute to the detrimental cognitive-emotional processes, including shame and guilt, which precipitate and maintain post-traumatic stress disorder. Yet, some persons experiencing trauma also experience post-traumatic growth as a result, exhibiting resiliency and, in some cases, even thriving. The mechanism of action for post-traumatic growth (PTG), which is conceptualized as a positive change following trauma (i.e., finding purpose and meaning in life), is unknown, but may involve adaptive schema restructuring (e.g., temporal shifts). Specifically, PTG may involve changes to time-perspective, or the tendency for a person to consider their life as a function of, or in the context of, the past (e.g., past trauma, nostalgia), present (e.g., positive/negative) or future (e.g., goals). The ability, for instance, to temporally transcend the past or present and focus on a more-adaptive future, may contribute to a reduction in the ruminative processes so often involved in shame and guilt, whereas maladaptive temporal views (e.g., negative past and present) may exacerbate guilt and shame. However, this premise has not been tested. We hypothesized that time perspective would mediate the association between PTG and shame/guilt, such that higher levels of PTG would be associated with higher levels of adaptive temporality/lower levels of maladaptive temporality and, in turn, to lower /higher levels of shame and guilt. Participants (N=545; 70.1% male (n=382); 86.4% Caucasian (n=469), Mean Age=49.86, SD=16.78) were community-dwelling veterans who self-identified as having experienced a trauma, and completed the PTG Inventory, Zimbardo Time Perspective Inventory, and Differential Emotions Scale-IV. Bivariate correlations and simple mediation analyses were conducted covarying age, sex, ethnicity, VHA usage, and service era. Supporting hypotheses, in simple mediation analyses (10000 bootstrapped samples), the direct effect of PTG on shame (DE=-.0134, SE=.0098, p=.1720, IE 95% CI=-.0327 to .0059) and guilt (DE=-.0085, SE=.0100, p=.3919, IE 95% CI=-.0281 to .0110) was reduced, and fell out of significance, when future time perspective was added as a mediator, indicating full mediation. The direct effects of PTG on shame and guilt were reduced, but remained significant, when present hedonistic, present fatalistic, past negative, and past positive were added as mediators, indicating partial mediation. Our results suggest that the relation between posttraumatic growth and shame/guilt may be due, in part, to changes in cognitive-emotional processing related to temporality. The PTG process may involve adaptive shifts in time perspective that, in turn, beneficially impact negative emotions associated with trauma exposure. Our findings may have clinical implications. Promotion of acceptance and meaning (e.g., via Acceptance and Commitment Therapy) to foster posttraumatic growth, and encouraging temporal holism (e.g., Cognitive Processing Therapy, Time Perspective Therapy), may reduce shame and guilt associated with trauma in the veteran population.

Suicide rates are higher in veterans compared to the general population, making up a disproportionate 22% of suicides reported annually in the U.S. One factor related to suicidal behavior among veterans is increased exposure to traumatic events. However, not all traumatized veterans engage in suicidal behavior, perhaps due to the presence of protective factors. One such factor, forgiveness (of self, others, and by God), conceptualized as a positive change in cognition, emotion, and behavior, toward a transgressor or transgression, may buffer against suicide risk by facilitating a “letting go” of experienced offenses, and by allowing individuals to respond to trauma in a meaningful way via posttraumatic growth (PTG). This premise has not been tested, however. We hypothesized that forgiveness and PTG would be positively related with each other, and negatively related to suicidal behaviors. We also hypothesized that PTG would mediate the association between forgiveness and suicidal behaviors, such that higher levels of forgiveness would be associated with greater PTG and, in turn, to less suicidal behavior. Participants (N=545; 70.1% male (n=382); 86.4% Caucasian (n=469), Mean Age=49.86, SD=16.78) were community-dwelling veterans who self-identified as having experienced a trauma, and completed the PTG Inventory, the forgiveness subscale from the Fetzer Multidimensional Measure of Religiousness and Spirituality, and Suicide Behaviors Questionnaire-Revised. Bivariate correlations and simple mediation analyses were conducted covarying age, sex, and ethnicity. Supporting bivariate hypotheses (p-values

Background: Posttraumatic-Stress Disorder (PTSD) is less common in older adults than in younger adults, and little is known about specific risk factors for PTSD in older adults. We investigated the association between self-esteem in late adolescence and PTSD in older adults. Method: Using a cohort design, 1,436 individuals who had been assessed approximately 40 years earlier in their junior and senior year of high school with the Rosenberg Self-Esteem Scale (RSES) were evaluated for PTSD using the PTSD Checklist (PCL-17). Results: Fully controlled logistic regression models indicated that lower self-esteem in late adolescence predicted PTSD in the overall sample of older adults but not in the veterans-only subgroup. Limitations: The main limitations include self-completed measures to estimate PTSD diagnosis and lack of specific information on traumatic events. Conclusions: Our findings suggest that lower self-esteem from a young age may be a risk factor for PTSD in older age.

No description available.

Men who were sexually abused during childhood (MSAC) represent a highly stigmatized, marginalized population at risk for a variety of psychological problems across the lifespan. Little research has been conducted to understand why some MSAC incur mental health problems and others do not. The purpose of this study was to identify which factors are related to mental distress among MSAC using a psychosocial trauma processing model: account-making. Using a cross-sectional design, the researcher collected data on 487 MSAC through an online survey. Multivariate analyses revealed that four abuse severity factors (clergy abuser, force, penetration, injury), disclosure variables (told after one year, response to first disclosure, overall response to disclosure, in-depth discussion), account-making, and high conformity to masculine norms were related to higher levels of mental distress. Furthermore, posttraumatic growth moderated the relationship between abuse severity variables (force, penetration) and mental distress. This study strengthened the knowledge base of MSAC, further developed account-making theory, and provided useful recommendations for clinical practice with this population. Future research areas were identified.

While many prevention and intervention strategies have been applied towards indigenous Pacific Island communities, these populations continue to observe upward trends in health disparities and documented shortfalls in the literature of culturally competent and sensitive practices. The purpose of this phenomenological study was to gain more understanding and insight of these communities through the conceptualizations of historical trauma (HT) and posttraumatic growth (PTG) theories. The central research question for this study examined how indigenous Pacific Island 3rd-generation adults described and perceived their experiences of intergenerational HT and potential growth. This study utilized a purposeful and criterion sample of 10 indigenous Pacific Island adults, between 18-32 years old, who participated in a project over 10 years ago. In the project, indigenous elders used the cultural tradition of oral storytelling, shared accounts of HT onto school aged children. Data were collected through semistructured interviews and qualitatively coded and analyzed using a modified thematic approach. Key findings indicated intergenerational HT effects as it related to participants' thoughts and feelings with concurrent positive experiences of increased values and engagement. The results also indicated PTG changes in appreciation of life, relating with others, personal strengths, new interests, and spiritual growth. Positive social change is implicated through the empirical evidence to inform researchers, policymakers, educators, and practitioners for further action, studies, and application of the culturally competent and sensitive strategy of shared familial oral traditions of storytelling as a means of preserving a community's history, found to increase PTG and reduce health disparities.

This paper aims to explore and discuss the points found in published research articles addressing posttraumatic stress disorder in children following the Bosnian Genocide, the terrorist attacks of 9/11, and Hurricane Katrina. The articles vary in their emphasis, methods, and conclusions, but all focus in one way or another on how the occurrence of war, terrorism, and natural disaster have resulted in posttraumatic stress disorder symptoms in youth. Intervention following traumatic events, however, rarely focus on treating mental health needs, and instead, focus on resolving any primary needs of vulnerable populations. The recommended treatment strategies for PTSD in youth require high quality mental health care and great accessibility for victims of trauma. Considering the high prevalence of PTSD in children following traumatic experiences, treatment of PTSD symptoms is necessary to ensure that youth can fully function in their daily lives without a constant reminder of the trauma they experienced.

Posttraumatic stress disorder (PTSD) has been linked to heightened engagement in risky sexual behavior (RSB) across diverse samples, and impulsivity has been postulated as a potential linkage (Weiss et al., 2012). Limited information has been published on the role that impulsivity can play in strengthening the relationship between PTSD and RSB in college students. The current study examined the moderating role of impulsivity dispositions: negative/positive urgency, (lack of) perseverance, sensation seeking, and (lack of) premeditation on the association between PTSD symptoms and past-year RSB among a sample of 221 undergraduate students (77.4% female) with at least one DSM-5 defined traumatic event. Negative binomial regression models were conducted to explore each impulsivity disposition’s moderating effect on the relationship between PTSD symptoms and RSB. PTSD symptoms and positive urgency, (lack of) perseverance, and sensation seeking were independently associated with RSB. Significant interactions were found between negative urgency and PTSD symptoms, and (lack of) premeditation and PTSD symptoms, such that PTSD symptoms were more strongly linked to RSB among individuals high in these impulsivity dispositions. The present study expands on the limited literature on the role specific impulsivity dispositions can have in the relationship between PTSD and RSB in trauma-exposed college students.