Jessica J. Fulton

The prevalence of posttraumatic stress disorder in Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans: A meta-analysis

Literature on posttraumatic stress disorder (PTSD) prevalence among Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) veterans report estimates ranging from 1.4% to 60%. A more precise estimate is necessary for projecting healthcare needs and informing public policy. This meta-analysis examined 33 studies published between 2007 and 2013 involving 4,945,897 OEF/OIF veterans, and PTSD prevalence was estimated at 23%. Publication year and percentage of Caucasian participants and formerly active duty participants explained significant variability in prevalence across studies. PTSD remains a concern for a substantial percentage of OEF/OIF veterans. To date, most studies have estimated prevalence among OEF/OIF veterans using VA medical chart review. Thus, results generalize primarily to the prevalence of PTSD in medical records of OEF/OIF veterans who use VA services. Additional research is needed with randomly selected, representative samples administered diagnostic interviews. Significant financial and mental health resources are needed to promote recovery from PTSD.

The two-factor model of psychopathic personality: Evidence from the Psychopathic Personality Inventory.

Psychopathy or psychopathic personality disorder represents a constellation of traits characterized by superficial charm, egocentricity, irresponsibility, fearlessness, persistent violation of social norms, and a lack of empathy, guilt, and remorse. Factor analyses of the Psychopathic Personality Inventory (PPI)typically yield two factors: Fearless Dominance (FD) and Self-Centered Impulsivity (SCI). Additionally, the Coldheartedness (CH) subscale typically does not load on either factor. The current paper includes a meta-analysis of studies that have examined theoretically important correlates of the two PPI factors and CH. Results suggest that (a) FD and SCI are orthogonal or weakly correlated, (b) each factor predicts distinct (and sometimes opposite) correlates, and (c) the FD factor is not highly correlated with most other measures of psychopathy. This pattern of results raises important questions about the relation between FD and SCI and the role of FD in conceptualizations of psychopathy. Our findings also indicate the need for future studies using the two-factor model of the PPI to conduct moderational analyses to examine potential interactions between FD and SCI in the prediction of important criterion measures.

Lead and Attention-Deficit/Hyperactivity Disorder (ADHD) Symptoms: A Meta-Analysis

This meta-analysis examined the association between Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms and lead exposure in children and adolescents. Thirty-three studies published between 1972 and 2010 involving 10,232 children and adolescents were included. There was a small to medium association between inattention symptoms and lead exposure (r=.16, k=27, p<.001) and a similar association between hyperactivity/impulsivity symptoms and lead exposure (r=.13, k=23, p<.001). There was significant heterogeneity among the effect sizes for both inattention symptoms and for hyperactivity/impulsivity symptoms, with studies using hair analysis to assess lead burden yielding substantially larger effect sizes than those using other methods. Excluding the hair analysis studies, the average rs were .14 for inattention (k=23, p<.001) and .12 for hyperactivity/impulsivity (k=21, p<.001). Overall, the relation between lead exposure and ADHD symptoms was similar in magnitude to the relation between lead exposure and decreased IQ and between lead exposure and conduct problems.

Lead and Conduct Problems: A Meta-Analysis

This meta-analysis examined the association between conduct problems and lead exposure. Nineteen studies on 8,561 children and adolescents were included. The average r across all 19 studies was .19 (p < .001), which is considered a medium effect size. Studies that assessed lead exposure using hair element analysis yielded considerably larger effect sizes than those that assessed lead exposure using blood, tooth, or bone lead levels. Excluding the 3 hair analysis studies, the average r was .15 (p < .001). The age of the participants did not significantly moderate the relation between lead exposure and conduct problems. Overall, the relation between lead exposure and conduct problems was strikingly similar in magnitude to the relation between lead exposure and decreased IQ.

Diagnostic efficiency of the AUDIT-C in U.S. veterans with military service since September 11, 2001.

BACKGROUND Alcohol screening with the 3-item alcohol use disorders identification test (AUDIT-C) has been implemented throughout the U.S. Veterans Health Administration. Validation of the AUDIT-C, however, has been conducted with samples of primarily older veterans. This study examined the diagnostic efficiency of the AUDIT-C in a younger cohort of veterans who served during Operation Enduring Freedom and/or Operation Iraqi Freedom (OEF/OIF). METHODS Veteran participants (N=1775) completed the alcohol use disorders identification test (AUDIT) and underwent the structured clinical interview for DSM-IV-TR for Axis I disorders (SCID) in research settings within four VA medical Centers. Areas under receiver operating characteristic curves (AUCs) measured the effiency of the full AUDIT and AUDIT-C in identifying SCID-based diagnoses of past year alcohol abuse or dependence. RESULTS Both measures performed well in detecting alcohol use disorders. In the full sample, the AUDIT had a better AUC (.908; .881-.935) than the AUDIT-C (.859; .826-.893; p<.0001). It is notable that this same result was found among men but not women, perhaps due to reduced power. Diagnostic efficiency statistics for the AUDIT and AUDIT-C were consistent with results from older veteran samples. The diagnostic efficiency of both measures did not vary with race or age. CONCLUSIONS Both the AUDIT and AUDIT-C appear to be valid instruments for identifying alcohol abuse or dependence among the most recent cohort of U.S. veterans with service during OEF/OIF within research settings.

Examining the Association Between Emotion Regulation Difficulties and Probable Posttraumatic Stress Disorder Within a Sample of African Americans

This study examined the associations between emotion dysregulation and probable posttraumatic stress disorder (PTSD) among 180 African American undergraduates enrolled in a historically black college in the southern United States. Trauma-exposed participants with probable PTSD reported significantly higher levels of overall emotion dysregulation and the specific dimensions of lack of emotional acceptance, difficulties engaging in goal-directed behavior when upset, difficulties controlling impulsive behaviors when distressed, and limited access to effective emotion regulation strategies than participants without Criterion A traumatic exposure and those with Criterion A traumatic exposure but no PTSD (controlling for age and negative affect). Furthermore, results indicated that participants with Criterion A traumatic exposure but no PTSD were significantly less likely to report difficulties controlling impulsive behaviors when distressed and limited access to effective emotion regulation strategies than participants without Criterion A traumatic exposure (controlling for age and negative affect). These findings extend extant research on the role of emotion dysregulation in PTSD, thus providing support for the relevance of emotion dysregulation to PTSD among African American adults in particular.

The relationship between anxiety sensitivity and disordered eating: The mediating role of experiential avoidance

This study examined the role of experiential avoidance in the association between dimensions of anxiety sensitivity (AS) and disordered eating. A sample of 395 undergraduate students completed a series of questionnaires assessing the constructs of interest. Results indicate that the AS dimension of fear of cognitive dyscontrol was significantly uniquely associated with disordered eating. Furthermore, results provide support for a model in which experiential avoidance mediates the association between fear of cognitive dyscontrol and disordered eating. Findings of the present study highlight one potential mechanism underlying the association between AS and disordered eating, suggesting that efforts to avoid internal experiences may play a role in eating pathology. Clinical implications of these findings are discussed.

Irrational health beliefs and health anxiety

The Irrational Health Belief Scale (IHBS) assesses the tendency to appraise health-related information in an irrational manner. Despite the central role that dysfunctional assumptions about health play in the cognitive-behavioral model of hypochondriasis and health anxiety, researchers have not examined the relation between health anxiety and the types of irrational health beliefs assessed by the IHBS. Two samples (n = 198, n = 295) of students completed the IHBS and measures of anxiety and health anxiety. In both studies, the IHBS was correlated with health anxiety, and this association was mediated by anxiety. These findings suggest that the range of dysfunctional beliefs associated with health anxiety is greater than was initially described by the cognitive-behavioral model.

Discrepancies Between Explicit and Implicit Self-Esteem: Implications for Mate Retention Strategies and Perceived Infidelity

ABSTRACT The purpose of the present study was to examine whether the association between explicit self-esteem and relationship outcomes was moderated by implicit self-esteem. This was accomplished by asking 210 undergraduates who were currently involved in romantic relationships to complete measures of their explicit self-esteem, implicit self-esteem, mate retention strategies, and likelihood of future infidelity. Implicit self-esteem was found to moderate the association between high explicit self-esteem and relationship outcomes for male participants such that men with discrepant high self-esteem (i.e., high explicit self-esteem but low implicit self-esteem) reported less use of mate retention strategies and perceived a greater likelihood of future infidelity in their relationships during the next year. These findings provide additional support for the idea that fragile self-esteem may have consequences for the manner in which individuals perceive their relationships.

Is Risky Sexual Behavior Continuous or Categorical? A Taxometric Analysis of the Sexual Risk Survey

Risky sexual behaviors are behaviors that involve the possibility of an adverse outcome, such as contracting a sexually transmitted infection or unwanted pregnancy. The question of whether risky sexual behavior exists as a discrete class (i.e., taxon) or as a dimensional construct has not previously been explored. The authors performed a set of taxometric analyses on 4 factor scales derived from the Sexual Risk Survey (Turchik & Garske, 2009) with data from 1,103 college students. The results provided consistent support for a dimensional latent structure in which variations in reported risky sexual behavior reflect differences in degree and not differences in kind. The implications of these findings for the assessment of risky sexual behavior are discussed.