Jennifer Alvarez

Unemployment Among Women Examining the Relationship of Physical and Psychological Intimate Partner Violence and Posttraumatic Stress Disorder

Prior research has demonstrated that intimate partner violence (IPV) is associated with employment instability among poor women. The current study assesses the broader relationship between IPV and womens workforce participation in a population-based sample of 6,698 California women. We examined past-year IPV by analyzing specific effects of physical violence, psychological violence, and posttraumatic stress disorder (PTSD) symptoms as predictors of unemployment. Results indicated substantial rates of unemployment among women who reported IPV, with rates of 20% among women who experienced psychological violence, 18% among women who experienced physical violence, and 19% among women with PTSD symptoms. When the relationship was adjusted for demographic characteristics and educational attainment, PTSD (adjusted odds ratio [AOR] = 1.60; 95% confidence interval [CI] = 1.22, 2.09) and psychological violence (AOR = 1.78; 95% CI = 1.36, 2.32), but not physical violence, were associated with unemployment. Implications for supported employment programs and workplace responses to IPV are discussed.

The interactive effects of emotional clarity and cognitive reappraisal in Posttraumatic Stress Disorder

The goal of this investigation was to examine how emotional clarity and a specific emotion regulation strategy, cognitive reappraisal, interact to predict Posttraumatic Stress Disorder (PTSD) symptom severity and positive affect among treatment seeking military Veterans (N=75, 93% male) diagnosed with PTSD. PTSD is a highly relevant context because PTSD features include heightened stress reactivity, diminished ability to differentiate and understand emotions, and reliance on maladaptive forms of emotion regulation. We found that the combination of high levels of emotional clarity and frequent use of cognitive reappraisal were associated with (a) lesser total PTSD severity after accounting for shared variance with positive affect and the extent to which emotions are attended to (attention to emotions), and (b) greater positive affect after accounting for shared variance with total PTSD severity and attention to emotions. This is the first study to demonstrate interactive effects of emotional clarity and cognitive reappraisal.

Changes in facets of mindfulness and posttraumatic stress disorder treatment outcome

Though there has been a recent surge of interest in the relations between facets of mindfulness and Posttraumatic Stress Disorder (PTSD), there has been a dearth of empirical studies investigating the impact of changes in facets of mindfulness on PTSD treatment outcomes. The present study tested the prospective associations between pre- to post-treatment changes in facets of mindfulness and PTSD and depression severity at treatment discharge, among 48 military Veterans in residential PTSD treatment adhering to a cognitive-behavioral framework. Together, changes in facets of mindfulness significantly explained post-treatment PTSD and depression severity (19-24% of variance). Changes in acting with awareness explained unique variance in post-treatment PTSD severity and changes in nonjudgmental acceptance explained unique variance in post-treatment depression severity. These results remained significant after adjusting for shared variance with length of treatment stay.

Lifetime interpersonal violence and self-reported Chlamydia trachomatis diagnosis among California women.

OBJECTIVE To examine the relationship between cumulative exposure to various types of interpersonal violence throughout the life span and self-reported history of Chlamydia trachomatis (CT) diagnosis in a population-based sample of California women. METHODS This was a cross-sectional analysis of a population-based survey of California women aged 18-44 years (n = 3521). Participants reported their experience of multiple types of interpersonal violence: physical or sexual abuse in childhood or adulthood and intimate partner violence (IPV) in the past 12 months. Current posttraumatic stress disorder (PTSD) and depressive symptoms were also reported. Separate logistic regression models assessed the association between experiencing each type of interpersonal violence, as well as womens cumulative exposure to violence, and past CT diagnosis, adjusting for age, race/ethnicity, and poverty, as well as mental health problems. RESULTS Six percent of women reported a past diagnosis of CT, and 40.8% reported experiencing at least one type of interpersonal violence in their lifetime. All types of violence were significantly associated with higher odds of having a past CT diagnosis even after controlling for sociodemographics. Women who reported experiencing four or more types of violence experiences had over five times the odds of reporting a lifetime CT diagnosis compared with women who never experienced interpersonal violence (adjusted odds ratio = 5.71, 95% CI 3.27-9.58). Current PTSD and depressive symptoms did not significantly affect the relationship between a womans cumulative experience of violence and her risk of past CT diagnosis. CONCLUSIONS There is a robust association between experiencing multiple forms of violence and having been diagnosed with CT. Women who seek treatment for sexually transmitted diseases (STDs), such as CT, should be assessed for their lifetime history of violence, especially violence in their current intimate relationships. Sexual risk reduction counseling may also be important for women who have a history of risky sexual behaviors and who are likely to be reinfected.

A psychophysiological investigation of emotion regulation in chronic severe posttraumatic stress disorder

There have been few direct examinations of the volitional control of emotional responses to provocative stimuli in PTSD. To address this gap, an emotion regulation task was administered to 27 Operation Enduring Freedom/Operation Iraqi Freedom combat veterans and 23 healthy controls. Neutral and aversive photographs were presented to participants who did or did not employ emotion regulation strategies. Objective indices included corrugator electromyogram, the late positive potential, and the electrocardiogram. On uninstructed trials, participants with PTSD exhibited blunted cardiac reactivity rather than the exaggerated cardioacceleratory responses seen in trauma cue reactivity studies. On interleaved regulation trials, no measure evidenced group differences in voluntary emotion regulation. Persons with PTSD may not differ from normals in their capacity to voluntarily regulate normative emotional responses to provocative stimuli in the laboratory, though they may nevertheless respond differentially on uninstructed trials and endorse symptoms of dyscontrol pathognomonic of the disorder outside of the laboratory.

Anxiety sensitivity and sleep quality: independent and interactive predictors of posttraumatic stress disorder symptoms.

Abstract A cardinal feature of posttraumatic stress disorder (PTSD) is decreased sleep quality. Anxiety sensitivity (AS) is one factor that has shown early theoretical and empirical promise in better understanding the relation between sleep quality and PTSD outcomes. The current study is the first to test the independent and interactive effects of sleep quality and AS on PTSD symptoms. Consistent with hypotheses, AS and sleep quality were found to be independent and interactive predictors of PTSD symptom severity in our sample of male military veterans seeking treatment for PTSD. Slope analyses revealed that AS was differentially related to PTSD symptom severity as a function of quality of sleep. The veterans with good sleep quality and relatively lower levels of AS had the lowest level of PTSD symptoms, whereas the veterans with poor sleep quality and low AS evidenced severity of PTSD symptoms similar to those with high AS.

Firearm Ownership Among Military Veterans With PTSD: A Profile of Demographic and Psychosocial Correlates.

Post-traumatic stress disorder (PTSD), a condition that disproportionately affects military veterans, is associated with heightened rates of aggression and suicide. Although experience with firearms is common among this population, virtually nothing is known regarding who is more likely to own a firearm and whether firearm ownership is differentially associated with psychological and behavioral risk factors among veterans with PTSD. Of 465 veterans (79% male) entering PTSD treatment, 28% owned a firearm (median number of firearms among owners = 3, range = 1-40). Firearm owners reported higher income were less likely to be unemployed, and were more likely to be male, Caucasian, married, and living in permanent housing. Ownership was associated with higher combat exposure and driving aggression, yet lower rates of childhood and military sexual trauma, suicidal ideation, and incarceration. Ownership was not associated with previous suicide attempt, arrest history, number of traumas experienced, PTSD symptoms, or depression. Together, among a sample of treatment-seeking military veterans with PTSD, those who owned a firearm appeared to demonstrate greater stability across a number of domains of functioning. Importantly though, routine firearm safety discussions (e.g., accessibility restrictions; violence risk assessments) and bolstering of anger management skills remain critical when working with this high-risk population.

Interactions between Handler Well-Being and Canine Health and Behavior in Search and Rescue Teams

ABSTRACT This study reports on three years of prospective, longitudinal data on the psychological well-being of the human handlers and the health and behavior of the search and rescue dogs deployed in New York City and Washington, DC in the aftermath of the terrorist attacks on September 11, 2001. Eighty-five human handlers (63 deployed and 22 controls) and ninetyfour dogs (66 deployed, 28 controls) were assessed at multiple time points including 6 months, 1 year, 2 years, and 3 years after the 9/11 attacks. Humans were assessed for psychological health by structured clinical interview and self-report. Dogs were assessed for physical health and behavior by veterinary records and handler report. For humans, deployment after 9/11 did indeed represent a relatively short-term risk factor for developing symptoms of depression and posttraumatic stress disorder (PTSD). By and large, however, the sample showed remarkable resilience as a whole, and overall rates of DSM-IV diagnoses were quite low. By year 3, 9/11 deployment no longer conferred any special risk. On the other hand, long-term employment in an emergency profession did emerge as a significant risk factor for symptoms of PTSD by year 3. With respect to the interaction between handler emotional well-being and canine health and behavior, we found that physical illness and/or death in the dog was prospectively associated with greater symptoms of depression in the handler. We also found that symptoms of depression and PTSD in the handlers prospectively predicted behavioral problems in the dogs over time. Separation anxiety, attachment/attention seeking, chasing, and excitability emerged in the dogs at 1 year. Behavioral problems escalated to aggression towards other dogs at year 2 and separation anxiety, aggression towards other dogs, and aggression towards strangers at year 3. Like any relationship, the partnership between a handler and his or her working dog can confer both protection—when the relationship is going well and both members are healthy—and vulnerability—when either member is physically ill or psychologically or behaviorally distressed.

Seated movement indexes emotion and its regulation in posttraumatic stress disorder

This paper reports the results of a study that administered an emotion regulation task to Operation Enduring Freedom/Operation Iraqi Freedom veterans diagnosed with posttraumatic stress disorder (27) and to healthy controls (23). Seated movement and postural responses were transduced with a sensitive accelerometer attached to the underside of a low-mass cantilevered chair. Consistent with prior studies in which subjects stood on force plates, aversive photographs induced attenuation of nondirectional movement in patients and controls. Regarding seated postural responses, controls leaned towards neutral photographs and away from aversive ones, while participants with PTSD did the opposite. Regulation had no impact on seated movement but was associated with a seated postural withdrawal from the computer screen.