Jon D. Elhai

Poly-Victimization and Risk of Posttraumatic, Depressive, and Substance Use Disorders and Involvement in Delinquency in a National Sample of Adolescents

PURPOSEnAdolescents exposed to multiple forms of psychological trauma (poly-victimization, Finkelhor et al. Child Abuse Negl 2007;31:7-26) may be at high risk for psychiatric and behavioral problems. This study empirically identifies trauma profiles in a national sample of adolescents to ascertain correlates of poly-victimization.nnnMETHODSnLatent Class analyses and logistic regression analyses were used with data from the National Survey of Adolescents to identify trauma profiles and each profiles risk of posttraumatic stress disorder, major depressive disorder, substance use disorders, and delinquency involvement and deviant peer group relationships. Poly-victimization classes were also compared to classes with trauma exposure of lesser complexity.nnnRESULTSnSix mutually exclusive trauma profiles (latent classes) were identified. Four classes were characterized by high likelihood of poly-victimization, including abuse victims (8%), physical assault victims (9%), and community violence victims (15.5%). Poly-victimization class members, especially abuse and assault victims, were more likely than do youth traumatized by witnessing violence or exposure to disaster/accident trauma to have psychiatric diagnosis and (independent of psychiatric diagnoses or demographics) to be involved in delinquency with delinquent peers.nnnCONCLUSIONSnPoly-victimization is prevalent among adolescents and places youth at high risk for psychiatric impairment and for delinquency. Moreover, poly-victimized youths risk of delinquency cannot be fully accounted for by posttraumatic stress disorder, depression, or substance use problems, suggesting that adolescent healthcare providers should consider poly-victimization as a risk for behavioral and legal problems even when PTSD, depression, or addiction symptoms are not clinically significant.

Evidence for a unique PTSD construct represented by PTSD's D1–D3 symptoms

Two models of posttraumatic stress disorder (PTSD) have received the most empirical support in confirmatory factor analytic studies: King, Leskin, King, and Weathers (1998) Emotional Numbing model of reexperiencing, avoidance, emotional numbing and hyperarousal; and Simms, Watson, and Doebbelings (2002) Dysphoria model of reexperiencing, avoidance, dysphoria and hyperarousal. These models only differ in placement of three PTSD symptoms: sleep problems (D1), irritability (D2), and concentration problems (D3). In the present study, we recruited 252 women victims of domestic violence and tested whether there is empirical support to separate these three PTSD symptoms into a fifth factor, while retaining the Emotional Numbing and Dysphoria models remaining four factors. Confirmatory factor analytic findings demonstrated that separating the three symptoms into a separate factor significantly enhanced model fit for the Emotional Numbing and Dysphoria models. These three symptoms may represent a unique latent construct. Implications are discussed.

Coping style use predicts posttraumatic stress and complicated grief symptom severity among college students reporting a traumatic loss

Problem-focused coping, and active and avoidant emotional coping were examined as correlates of grief and posttraumatic stress disorder (PTSD) severity among 123 college students reporting the unexpected death of an immediate family member, romantic partner, or very close friend. The authors administered to participants, via the Internet, 5 survey instruments that measured demographic characteristics, traumatic event exposure (Stressful Life Events Screening Questionnaire; L. Goodman, C. Corcoran, K. Turner, N. Yuan, & B. L. Green, 1998), complicated grief (CG) severity (Inventory of Complicated Grief-Revised-Short Form; A. E. Latham & H. G. Prigerson, 2004; H. G. Prigerson & S. C. Jacobs, 2001), PTSD severity (PTSD Checklist; F. W. Weathers, B. T. Litz, D. S. Herman, J. A. Huska, & T. M. Keane, 1993), and coping style use (Brief COPE; C. S. Carver, 1997). Results demonstrated that CG and PTSD severity were both significantly positively correlated with problem-focused, and active and avoidant emotional coping styles. The authors used path analysis to control for time since the loss and trauma frequency and found that only avoidant emotional coping remained significant in predicting CG and PTSD severity. Results are discussed in terms of their clinical implications for treating individuals with traumatic losses.

Reliability and validity of the Attitudes Toward Seeking Professional Psychological Help Scale-Short Form

We examined the reliability and validity of the Attitudes Toward Seeking Professional Psychological Help Scale-Short Form (ATSPPH-SF), a widely cited measure of mental health treatment attitudes. Data from 296 college students and 389 primary care patients were analyzed. The ATSPPH-SF evidenced adequate internal consistency. Higher scores (indicating more positive treatment attitudes) were associated with less treatment-related stigma, and greater intentions to seek treatment in the future. No associations were found for mental health impairment or depression. The ATSPPH-SF was related to the recent use of mental health treatment and recent treatment intensity (i.e., visit counts); after controlling for demographic variables associated with treatment use, this relationship held in predicting previous use from non-use, but not visit counts. Factor-analytic findings demonstrated that a two-factor model (Openness to Seeking Treatment for Emotional Problems, and Value and Need in Seeking Treatment) represented the data well. Implications for future research on mental healthcare use correlates are discussed, as well as the need for enhancing peoples attitudes toward treatment.

Health Service Use Predictors Among Trauma Survivors: A Critical Review

Summary of Service Use DeterminantsAmong Trauma Survivors and PTSDPatients Although numerous instances of inconclusiveÞndings exist, several general conclusions canbe drawn across studies (with at least a ratio of3:1 studies supporting a given conclusion and atleast three studies examining the given vari-able). Increased MH service use was found forwomen, people with previous or lifetime traumahistories, and people with a PTSD diagnosis.Increased medical service use was found forpeople with a PTSD diagnosis.However,theseconclusionsareinsuencedbythe fact that some studies may not possess ad-equate statistical power to reveal signiÞcant ef-fects. Therefore, we reassessed our general con-clusions after removing from consideration theseven small-sample ( N 100) studies. As aresult, the only modiÞcation to our conclusions(across studies) would be the addition of PTSDseverity as a variable associated with increasedMH service use. Caveat One particular limitation of this reviewshould be emphasized. We included studies thatsampled very different types of trauma survi-vors, an approach we acknowledge as particu-larly inclusive. Traumatic experiences reportedby war soldiers, for example (being both vic-tims and trained agents of insicting trauma), arevery different from those experienced by disas-ter survivors (being unexpected victims of nat-ural or man-made disasters). Additionally, theresulting psychopathology from different typesof traumatic events can vary widely; for exam-ple, combat exposure and sexual assault areassociated with much higher PTSD rates than isdisaster (Kessler et al., 1995).Additionally, the services available to differ-enttypesoftraumasurvivorscanvary.Veteransof war trauma can qualify for services withinthe VA Medical Center, a relatively closedhealth care system, which is inexpensive to vet-erans but can yield relatively long wait times.Conversely, civilian trauma survivors must seekservices in the community, perhaps throughtheir health insurance plans (and in the case ofcriminal victimization, they may have access tocrime victim compensation).

Exposure-based cognitive-behavioral treatment of PTSD in adults with schizophrenia or schizoaffective disorder : A pilot study

In an open trial design, adults (n=20) with posttraumatic stress disorder (PTSD) and either schizophrenia or schizoaffective disorder were treated via an 11-week cognitive-behavioral intervention for PTSD that consisted of education, anxiety management therapy, social skills training, and exposure therapy, provided at community mental health centers. Results offer preliminary hope for effective treatment of PTSD among adults with schizophrenia or schizoaffective disorder, especially among treatment completers (n=13). Data showed significant PTSD symptom improvement, maintained at 3-month follow-up. Further, 12 of 13 completers no longer met criteria for PTSD or were considered treatment responders. Clinical outcomes for other targeted domains (e.g., anger, general mental health) also improved and were maintained at 3-month follow-up. Participants evidenced high treatment satisfaction, with no adverse events. Significant improvements were not noted on depression, general anxiety, or physical health status. Future directions include the need for randomized controlled trials and dissemination efforts.

Statistical procedures for analyzing mental health services data.

In mental health services research, analyzing service utilization data often poses serious problems, given the presence of substantially skewed data distributions. This article presents a non-technical introduction to statistical methods specifically designed to handle the complexly distributed datasets that represent mental health service use, including Poisson, negative binomial, zero-inflated, and zero-truncated regression models. A flowchart is provided to assist the investigator in selecting the most appropriate method. Finally, a dataset of mental health service use reported by medical patients is described, and a comparison of results across several different statistical methods is presented. Implications of matching data analytic techniques appropriately with the often complexly distributed datasets of mental health services utilization variables are discussed.

Differences in posttraumatic stress disorder diagnostic rates and symptom severity between Criterion A1 and non-Criterion A1 stressors

This study addresses the ongoing controversy regarding the definition of DSM-IV posttraumatic stress disorders (PTSD) traumatic stressor criterion (A1). A sample of 119 college students completed the PTSD Symptom Scale separately in relation to both Criterion A1 and non-Criterion A1 stressful events, using a mixed between-groups (administration order) and within-subjects (stressor type) design. Contrary to what was expected, analyses revealed that non-Criterion A1 events were associated with greater likelihood of probable PTSD diagnoses and a greater PTSD symptom frequency than Criterion A1 events. Symptom frequency relationships, however, were moderated by the order in which the measures were administered. The non-Criterion A1 PTSD scores were only higher when non-Criterion A1 measures were presented first in the administration order. Similar patterns of differences in PTSD scores between stressor types were also found across the three PTSD symptom criteria. Implications are discussed as to the ongoing controversy of the PTSD construct.

Diagnostic alterations for post-traumatic stress disorder: examining data from the National Comorbidity Survey Replication and National Survey of Adolescents

BACKGROUNDnTwo alternative models of post-traumatic stress disorder (PTSD) appear to represent the disorders latent structure better than the traditional Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) three-factor PTSD model. The present study examines the impact of using these structural models for the diagnosis of lifetime PTSD while retaining the DSM-IV PTSDs six-symptom diagnostic requirement.nnnMETHODnData were gathered from large-scale, epidemiological datasets collected with adults (National Comorbidity Survey Replication) and adolescents (National Survey of Adolescents). Two alternative, empirically supported four-factor models of PTSD were compared with the DSM-IV three-factor PTSD diagnostic model.nnnRESULTSnResults indicated that the diagnostic alterations resulted in substantially improved structural validity, downward adjustments of PTSDs lifetime prevalence (roughly 1 percentage point decreases in adults, 1-2.5 percentage point decreases in adolescents), and equivalent psychiatric co-morbidity and sociodemographic associations.nnnCONCLUSIONSnImplications for modifying PTSD diagnostic criteria in future editions of DSM are discussed.

Trauma professionals' attitudes toward and utilization of evidence-based practices

This study was designed to evaluate attitudes toward and utilization of evidence-based practices (EBPs) among mental health professionals specializing in trauma. An Internet survey was completed by 461 trauma professionals who were recruited via International Society for Traumatic Stress Studies membership rolls and electronic mailing lists of trauma special interest groups. Although a minority of participants held negative views of EBPs, the overwhelming majority of respondents were supportive of the EBP movement. Theoretical orientation, training model, and age were associated with EBP attitudes. Favorable EBP attitudes were not as strongly related to reported clinical behaviors as might reasonably be expected. Even respondents utilizing unsupported treatments espoused positive EBP opinions, suggesting that practitioners may hold widely varying evidentiary standards.