Amee J. Epler

Screening for post-traumatic stress disorder in female Veteran’s Affairs patients: validation of the PTSD checklist

We evaluated the screening validity of a self-report measure for post traumatic stress disorder (PTSD), the PTSD Checklist (PCL), in female Veterans Affairs (VA) patients. All women seen for care at the VA Puget Sound Health Care system from October 1996-January 1999 (n=2,545) were invited to participate in a research interview. Participants (n=282) completed the 17-item PCL, followed by a gold standard diagnostic interview for PTSD, the Clinician Administered PTSD Scale (CAPS). Thirty-six percent of the participants (n=100) met CAPS diagnostic criteria for current PTSD. Receiver Operating Characteristic (ROC) analysis was used to evaluate the screening performance of the PCL. The area under the ROC curve was 0.86 (95% CI 0.82-0.90). A PCL score of 38 optimized the performance of the PCL as a screening test (sensitivity 0.79, specificity 0.79). The PCL performed well as a screening measure for the detection of PTSD in female VA patients.

The subjective effects of alcohol-tobacco co-use: an ecological momentary assessment investigation.

Alcohol and tobacco use covary at multiple levels of analysis, and co-use of the 2 substances may have profound health consequences. To characterize the motivationally relevant processes contributing to co-use, the current study used ecological momentary assessment (EMA) to examine the subjective consequences of naturally occurring simultaneous use of alcohol and tobacco. Current smokers who reported frequently drinking alcohol (N=259) used electronic diaries to monitor their daily experiences for 21 days. Participants responded to prompted assessments and also initiated recordings when they smoked a cigarette or completed the first drink in a drinking episode. Momentary reports of smoking and alcohol consumption were associated with one another, and these effects remained after adjustment for occasion- and person-level covariates. When participants consumed alcohol, they reported increased pleasure and decreased punishment from the last cigarette. Smoking was associated with small increases in pleasure from the last drink. Ratings of buzzed and dizzy were synergistically affected by co-use of alcohol and tobacco. Co-use was also followed by higher levels of craving for both alcohol and tobacco. Results point to the importance of reward and incentive processes in ongoing drug use and suggest that alcohol intensifies real-time reports of the motivational consequences of smoking more strongly than smoking affects corresponding appraisals of alcohol effects.

THE EFFECT OF DIALECTICAL BEHAVIOR THERAPY SKILLS USE ON BORDERLINE PERSONALITY DISORDER FEATURES

We assessed the effect of DBT skills utilization on features of borderline personality disorder as measured by the Personality Assessment Inventory-Borderline Features Scale (PAI-BOR). Participants were outpatients (N = 27) enrolled in a dialectical behavior therapy (DBT) program in a university-affiliated community mental health clinic. Diary cards were collected each week to track self-reported skills use. At the beginning of each new skills training module, patients completed another PAI-BOR. Univariate and multilevel analyses indicated significant improvement on the total PAI-BOR score and on several PAI-BOR subscale scores. Results also revealed that overall DBT skills use increased significantly over time, as did individual skills related to mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance. Multilevel modeling results indicated that overall skills use showed a significant effect on PAI-BOR total scores, Affective Instability scores, Identity Problems scores, and Negative Relationships scores, even after controlling for initial levels of distress and diary card compliance.

Reasons for abstaining or limiting drinking: a developmental perspective.

The cross-sectional and longitudinal relations between reasons for abstaining or limiting drinking (RALD) and abstention were examined in a 16-year longitudinal study (N = 489) of college students with and without a family history of alcohol problems. Results indicated that RALD based upon upbringing or religiosity were associated with increased rates of abstention, whereas RALD based upon perceived or experienced negative consequences of drinking were associated with lower rates of abstention and increased alcohol consumption among drinkers. In addition, changes in RALD over time coincided with alcohol consumption transitions. Abstainers who began drinking after turning 21 reported a decrease in the importance of RALD associated with loss of control and upbringing or religiosity compared to abstainers who continued to abstain after turning 21. Conversely, drinkers who began abstaining after leaving college reported an increase in the importance of RALD associated with loss of control and upbringing or religiosity compared to drinkers who continued to drink after leaving college. Examining the reciprocal influences of RALD on drinking outcomes extends previous research and may inform prevention and intervention programs among college drinkers.

Are there developmentally limited forms of bipolar disorder

Bipolar spectrum disorders have traditionally been thought to be chronic in course. However, recent epidemiologic research suggests that there may be developmentally limited forms of bipolar disorder. Two large, nationally representative studies reveal a strikingly high prevalence of bipolar disorders in emerging adulthood (5.5%-6.2% among 18-24-year-olds) that appear to resolve substantially during the latter half of the 3rd decade of life (3.1%-3.4% among 25-29-year-olds). Although ascertainment bias due to early mortality, institutionalization, incarceration, and homelessness may account for some of this reduction, the prevalence distribution suggests a high incidence in late adolescence and emerging adulthood that appears to resolve spontaneously in most cases. There were very few differences across age groups in symptom endorsement and comorbid diagnoses, suggesting that 18-24-year-olds that meet criteria for bipolar diagnoses experience clinically significant impairment and associated consequences of the disorder. More fine-grained longitudinal research is needed to determine whether developmentally limited forms of bipolar disorder exist and, if so, what markers might distinguish these forms of the disorder from more chronic courses.

Concerns related to eating, weight, and shape: Typologies and transitions in men during the college years

OBJECTIVE How to best classify concerns related to eating, weight, and shape (CREWS) in men remains an open question. Research on men considering CREWS during different developmental periods could be particularly informative. METHOD Focusing on one potentially dynamic developmental period, this study charts the course of CREWS in men over the college years. Latent class/latent transition analysis identified typologies of weight- and shape-influenced self judgment, limiting attempts, fasting, overeating, binge eating, self-induced vomiting, and laxative or diuretic abuse for 1,025 men over the four traditional college years. RESULTS Three classes emerged: (1) no obvious pathological eating-related concerns (61-65%); (2) a high likelihood of limiting attempts and a moderately high likelihood of overeating (31-34%); (3) pervasive bulimic-like concerns (4-6%). Class membership was highly stable across assessment occasions. DISCUSSION The results contribute to the growing literature on empirically derived classifications of CREWS and indicate that for many men CREWS are a chronic presence during the college years.

Stability and Change in Patterns of Concerns Related to Eating, Weight, and Shape in Young Adult Women: A Latent Transition Analysis

Although college women are known to be at high risk for eating-related problems, relatively little is known about how various aspects of concerns related to eating, weight, and shape are patterned syndromally in this population. Moreover, the extent to which various patterns represent stable conditions or transitory states during this dynamic period of development is unclear. The present study used latent class and latent transition analysis (LCA/LTA) to derive syndromes of concerns related to eating, weight, and shape and movement across these syndromes in a sample of 1,498 women ascertained as first-time freshmen and studied over 4 years. LCA identified 5 classes characterized by (a) no obvious pathological eating-related concerns (prevalence: 28%-34%); (b) a high likelihood of limiting attempts (prevalence: 29%-34%); (c) a high likelihood of overeating and binge eating (prevalence: 14%-18%); (d) a high likelihood of limiting attempts and overeating or binge eating (prevalence: 14%-17%); and (e) pervasive bulimic like concerns (prevalence: 6%-7%). Membership in each latent class tended to be stable over time. When movement occurred, it tended to be to a less severe class. These findings indicate that there are distinct, prevalent, and relatively stable forms of eating-related concerns in college women.

Does Hangover Influence the Time to Next Drink? An Investigation Using Ecological Momentary Assessment

BACKGROUND Measures of hangover are associated with current and future problematic alcohol use. At present, it is not known whether these associations reflect any direct influence of hangover events on near-term drinking behaviors. The current study aimed to determine whether hangover following a drinking episode influences time to next drink (TTND) and, if so, to determine the direction of this effect and identify any moderating personal or contextual factors. METHODS Community-recruited, frequent drinkers oversampled for current smoking (N = 386) carried electronic diaries for 21 days, reporting on drinking behaviors and other experiences. Survival analysis was used to model data from 2,276 drinking episodes, including 463 episodes that were followed by self-reported hangover in morning diary entries. RESULTS When tested as the sole predictor in a survival model, hangover was associated with increased TTND. The median survival time was approximately 6 hours longer after episodes with hangovers compared to those without. In a multivariate model, hangover was only significant in the presence of interaction effects involving craving at the end of the index drinking episode and the occurrence of financial stressors. Additional predictors of TTND in the final multivariate model included age, lifetime alcohol use disorder diagnosis, typical drinking frequency, day of the week, and morning reports of craving, negative affect, and stressors after the index episode. There was no association between morning reports of hangover and contemporaneous diary ratings of likelihood of drinking later the same day. CONCLUSIONS The findings suggest that hangover has, at best, a modest or inconsistent influence on the timing of subsequent alcohol use among frequent drinkers.

College Student Receptiveness to Various Alcohol Treatment Options

Objective: Heavy episodic drinking remains a significant problem on college campuses. Although most interventions for college students are behavioral, pharmacological treatments, such as naltrexone, could provide additional options. Participants: The authors evaluated receptivity to various alcohol treatment options in a general population of college student drinkers (N = 2,084), assessed in 2005. Methods: The authors asked participants to indicate which of 8 treatment options (ie, self-help book, self-help computer program, self-help group, group therapy, individual therapy, monthly injection, targeted oral medication, or daily oral medication) they would be willing to consider if they were going to cut down on or stop drinking. Results: Over 50% of drinkers expressed receptiveness to self-help options or psychotherapy options, and over 25% of drinkers expressed receptiveness to medication options. Conclusions: Increasing treatment options for students interested in reducing or stopping drinking by offering pharmacological interventions such as naltrexone could provide an important unmet need among college students.