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.

Low back pain (LBP) is the top reason for Soldiers to seek medical care and one of the top reasons to be medically discharged. Mental health problems and psychosocial stressors have been increasing in Soldiers and are also top causes for medical discharge. Dysregulated stress has contributed to many Soldiers and Veterans to develop chronic LBP as well as mental health disorders like post-traumatic stress disorder (PTSD). Research suggests that psychosocial characteristics, as opposed to physical factors or tissue health, contribute to chronic pain the most. Focusing entirely on tissues for individuals seeking care for LBP can increase disability and vulnerability. Attributing physical pain to mental health concerns, however, risks stigmatizing patients or making them feel dismissed. The purpose of this dissertation was to develop a pain neuroscience education (PNE) program for Veterans and Soldiers with LBP and stress and determine if PNE is more effective in improving disability, PTSD symptoms, and beliefs about pain compared to traditional education about back pain and stress. This dissertation demonstrated that Veterans with PTSD can comprehend the neuroscience of pain and PTSD at a comparable level to a highly educated Veteran and medical panel without PTSD when adjusting for education. Since a proportion of participants were concerned that using military examples in PNE might increase PTSD symptoms, however, results from pilot testing suggested that the PNE materials developed for this dissertation should be tested in a clinical trial to ensure they do not increase PTSD symptoms. A systematic review and meta-analysis demonstrated that Veterans with PTSD have higher depression and pain-catastrophizing beliefs for a large effect size compared to Veterans without PTSD. Furthermore, Veterans with PTSD have significantly lower pain self-efficacy with a large effect size. Compared to Veterans without PTSD, Veterans with PTSD have higher pain and disability. These results, however, were not confirmed in Veterans presenting to a Physical Therapy clinic. In fact, this dissertation revealed that many of the negative outcomes previously attributed to PTSD in the literature may be due to the correlation between PTSD symptoms and pain-catastrophizing beliefs rather than from trauma. Furthermore, Veterans with chronic LBP do not appear to have different sensitivity levels to pressure based on PTSD symptoms. Finally, the results from a randomized controlled trial provide evidence that PNE greatly improves the confidence of Veterans and Soldiers to increase participation in social, work, and life roles despite the pain as measured by the pain self-efficacy questionnaire. Participants in the experimental group were more likely to achieve a meaningful reduction in disability at the 8-week follow-up compared to the control group. Furthermore, Veterans and Soldiers with LBP were more satisfied with how PNE explains pain and believed the PNE curriculum connected with their military experiences better than traditional psychosocial education about stress. Participants in the experimental arm were less likely to believe that exercise is harmful compared to traditional education. Finally, PNE improved PTSD symptoms beyond the clinically meaningful threshold in the experimental arm. In conclusion, PNE appears to be an effective treatment for PTSD, disability, and pain-related beliefs in Veterans and Soldiers with chronic LBP. These results should be replicated in a larger sample to ensure generalizability beyond the current study.

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.

Posttraumatic stress disorder (PTSD) is a serious condition with debilitating symptoms which affects military veterans and has been understudied in the older population. Aside from treating the veterans of the Vietnam War and World War II, as service members from more recent conflicts age, the mental healthcare system needs to be able to treat them with empathy and effective therapies. As there is a need for future research focusing on this population, this paper reviews the current literature and utilizes Grounded theory to further the research related to PTSD in aging veterans. A selection of mental health clinicians with experience treating this population were interviewed and the results discussed. Those therapists who work for the Department of Veterans Affairs (VA) most often use Cognitive Behavioral Therapy to treat their clients, with Prolonged Exposure Therapy being the next most popular therapeutic modality. Those clinicians who are separate from the VA are able to employ therapies such as Cognitive Restructuring or blend theories to meet the precise needs of individual veterans. Also addressed are the differences and commonalities in PTSD symptoms between veterans of different conflict eras. Based upon these interviews, suggestions were made for changes to the treatment of military-related PTSD.

While there is considerable research linking trauma to psychological distress, such as posttraumatic stress disorder (PTSD), among military populations, some service members may develop other variants of psychological difficulties following exposure to traumatic life events. For example, moral injury, a more recently studied outcome within the field of trauma, is conceptualized to occur when a person perceives their response to a morally challenging situation as a transgression that may lead to an incongruence with their morals producing moral emotions (i.e., shame, guilt, and anxiety; Litz et al., 2009). The current study investigated the role of self-compassion in the relationship between moral injury and psychological distress (i.e., PTSD and depression) among a sample of 216 military veterans recruited from TurkPrime online panels. Among these military veterans, a conditional process analysis of our moderated mediation model suggests an indirect effect of moral injury predicting depression symptoms through guilt, Index = 1.469, SE = .460, 95% CI [.602, 2.409] and shame, Index = -.803, SE = .346, 95% CI [-1.552, -.161] was conditioned on different levels of self-compassion. Findings are expected to have important implications for treatment conceptualization for military populations.

Posttraumatic stress disorder (PTSD) affects more than 60% of Cambodian immigrants in the United States. However, researchers do not yet know why less than 5% of Cambodian immigrants are accessing mental health services. This qualitative study involved investigation of participants' perceptions of how PTSD is manifested in the Cambodian immigrant community to understand barriers to mental health services access. The social ecological theory provided a frame for understanding how traditions, values, culture, and beliefs affect Cambodian immigrants' perceptions of PTSD and the mental health system. Data was collected from semi structured interviews of 13 participants, 18 to 70 years of age, residing in Stockton, California, who shared their perceptions of PTSD. NVIVO was used to organize each data category for thematic analysis. The themes included: (a) hearing of PTSD, (b) meaning of PTSD, (c) contributing factors, (d) healing practices, (e) recognition of PTSD, (f) reactions, (g) reasons most often given, (h) encouraging family members, (i) healing practices, (j) ways of helping, (k) counseling, (l) medications, (m) mental health support, (n) mental health resources, and (o) want more information. The findings indicated that stigma continues to be one of the barriers in accessing mental health services, and that Cambodian immigrants have a strong desire to learn more about mental health and mental health services in San Joaquin County. Results from this study contribute to an area of mental health research that is limited, and they may be used by researchers and mental health practitioners to improve cultural understanding and awareness among diverse communities and help reduce the stigma regarding mental health issues.

acase@tulane.edu

BACKGROUND: Female veterans are at risk for stress-related physical disorders given unique environmental stress factors, high rates of trauma exposure and a heightened physiologic stress response. There is a need to identify modifiable risk factors which may help minimize the emergence and impact of veteran illness. RESEARCH QUESTION: The present study investigated the contributions of posttraumatic stress symptoms, maladaptive repetitive thought (MRT), depression, childhood trauma and health behaviors (sleep, alcohol use and smoking) to physical disease as operationalized by immune-mediated inflammatory disease occurrence and related functional disability. METHOD: Female Reserve or National Guard veterans (N = 643) enrolled in a parent study conducted through the Iowa City Veteran's Affairs Hospital completed a one-time computer-assisted telephone interview. The current study examined self-report measures of posttraumatic stress symptoms, MRT, depression, childhood trauma, smoking, alcohol use, sleep, inflammatory disease incidence and physical functioning. RESULTS: Proposed models of primary hypotheses were tested using structural equation modeling. Results indicated that both physical disease and functional decline were greater in veterans reporting a history of trauma. Physical disease was associated with greater depression and childhood trauma but lower levels of alcohol use after accounting for covariates. Unexpectedly, greater MRT was associated with less physical disease, although it was only related to disease when depression was included as a covariate. Reduced sleep was linked with greater disease but only when depression was not included in the model, and depression was found to fully mediate the relationship between sleep and physical disease. Smoking and the interaction between posttraumatic stress symptoms and MRT were generally unrelated to physical disease in this sample. CONCLUSIONS: Results of this study are consistent with the hypothesis that physical disorders and related functional decline are greater in trauma-exposed individuals and that depression, childhood trauma, repetitive thought and alcohol use have independent associations with physical disease. This study offers support for further research and interventions which address these relationships to protect female veteran health.

Dementia is a major public health problem worldwide. Emerging research indicates that clinical infections and PTSD could be important risk factors for dementia. However, evidence for infections and the risk of dementia primarily examines central nervous system (CNS) infections. Extant epidemiological evidence for systemic bacterial infections and the risk for dementia is limited while that for PTSD and the risk for dementia did not account for psychotropic medications commonly used in management of PTSD and could affect cognitive function. The purpose of this study was to 1) review the evidence for CNS infections as possible causes of Alzheimer’s disease (AD) dementia, and 2) using nationwide Veterans Health Administration databases, conduct original retrospective cohort analyses in nationally representative samples of U.S. veterans aged 56 years and older to determine the associations between systemic bacterial infections, PTSD, and psychotropic PTSD medication use with the risk for developing dementia. Review of the research pertaining to an infectious AD etiology hypothesis including the various mechanisms through which different clinical and subclinical infections could cause or promote the progression of AD, and the concordance between putative infectious agents and the epidemiology of AD showed evidence linking AD to an infectious cause to be largely inconclusive; however, the amount of evidence suggestive of an association is too substantial to ignore. Analysis of the associations between systemic bacterial infections and the risk for dementia showed a significant association between exposure to any systemic bacterial infection and an increased risk for dementia (hazard ratio [HR] = 1.20; 95% confidence interval [CI] = 1.16-1.24) after adjustment for demographic characteristics, and medical and psychiatric comorbidity. In addition, septicemia (HR=1.39; 95%CI=1.16-1.66), bacteremia (HR=1.22; 95%CI=1.0-1.49), osteomyelitis (HR=1.20; 95%CI=1.06-1.37), pneumonia (HR=1.10; 95%CI=1.02-1.19), UTI (HR=1.13; 95%CI=1.08-1.18), and cellulitis (HR=1.14; 95%CI=1.09-1.20) were independently associated with significantly increased risk of developing dementia after adjustment for potential confounders. Analysis of the associations between PTSD and psychotropic PTSD medication use with the risk for dementia showed a significant association between PTSD and the risk for dementia (HR=1.35; 95%CI=1.27-1.43) after adjustment for demographic characteristics, medical and psychiatric comorbidity, and health care utilization. Analysis of the impact of psychotropic PTSD medications including selective serotonin reuptake inhibitors (SSRI), serotonin-norepinephrine reuptake inhibitors (SNRI), benzodiazepines (BZA), novel antidepressants (NA) and atypical antipsychotics (AA) on the association between PTSD and the risk for dementia showed significant interactions between PTSD and use of SSRIs (p<.0001), NAs (p=.0016), and AAs (p<.0001). Multivariate analysis showed a significant association between PTSD and an increased risk for dementia among individuals not using any psychotropic PTSD medications at baseline (HR=1.70; 95%CI=1.58-1.82). PTSD patients using SSRIs (HR=2.10; 95%CI=1.82-2.41), NAs (2.19; 95%CI=1.94-2.48) or AAs (4.56; 95%CI=4.04-5.15) were significantly more likely to develop dementia compared to those without PTSD and not using any psychotropic PTSD medications. PTSD patients using SSRIs (HR=1.24; 95%CI=1.08-1.42), NAs (HR=1.29; 95% CI=1.14-1.46) or AAs (HR=2.69; 95%CI=2.38-3.04) were also significantly more likely to develop dementia compared to those with PTSD and not using any psychotropic PTSD medications. SNRI (HR=1.35; 95%CI=1.26-1.46) and BZA drug use (HR=1.40; 95%CI=1.35-1.45) at baseline was associated with an increased risk for dementia regardless of PTSD diagnosis. These findings indicate; 1) evidence for an infectious AD etiology hypothesis in inconclusive, 2) both severe (e.g. sepsis), and less severe (e.g. cellulitis) systemic bacterial infections are collectively and independently associated with an increased risk of dementia among older U.S. veterans hence prevention of systemic bacterial infections could positively influence the risk for dementia among older adults, and 3) PTSD and psychotropic medication use are associated with an increased risk for dementia among U.S. veterans. Further epidemiologic, clinical, and basic science research is required to elucidate the mechanisms and the associations between infections and the risk for dementia and to determine if the independent and effect modifying impacts of psychotropic PTSD medication use on the risk for dementia are related to differences in PTSD severity, other psychiatric comorbidity, or whether psychotropic PTSD medication use is an independent risk factor for dementia.

My research focused on five women in Aotearoa naming and defining their experiences ten or more years after leaving an intimate partner violence relationship. An increasing amount of literature has been published reporting the prevalence of intimate partner violence among women in our society, including surveys documenting devastating short and long-term health effects. However, little has been published about the long-term experiences of women who have survived such abuse. I was interested in making more visible the experiences of long-term survivors of intimate partner violence. I wondered what the challenges and legacies from experiences of intimate partner violence are and what contributes to women rebuilding their lives after intimate partner violence. In this research utilised a participatory action research approach informed by a critical feminist theoretical perspective. I selected two data collection methods, individual interviews followed by a focus group interview bringing the participants together. The findings identified nineteen themes emerging from the individual and focus group interviews. Some expressed the long-term challenges and legacies of intimate partner violence, such as feelings of powerlessness, guilt and shame and feeling silenced. Others reflected ways women rebuilt their lives, such as empowerment, resilience, courage and the importance of education and meaningful work. Interpreting the findings, empowerment was often juxtaposed with powerlessness, living side by side within the inner world of the long-term survivor of intimate partner violence in equal tension. This study affirms that challenges and legacies from intimate partner violence continue to affect women many years after leaving violence. Despite these challenges and legacies, women work very hard to rebuild their lives, care for their children and attain autonomy, independence and control of their lives. Women spent time and energy to recover ‘well enough’ from such violence, in order to lead a productive and functioning life.