Lisa A. Paul

Trauma exposure and posttraumatic stress disorder in adults with severe mental illness: A critical review.

There is a great deal of research on the prevalence, correlates, and treatment of PTSD in the general population. However, we know very little about the manifestation and consequences of PTSD in more complicated patient populations. The purpose of the current paper is to provide a comprehensive review of PTSD within the context of severe mental illness (SMI; i.e., schizophrenia spectrum disorders, mood disorders). Extant data suggest that trauma and PTSD are highly prevalent among individuals with SMI relative to the general population, and both are associated with adverse clinical functioning and increased healthcare burden. However, trauma and PTSD remain overlooked in this population, with low recognition rates in public-sector settings. Additionally, there are few data on the clinical course and treatment of PTSD among individuals with SMI. Particularly lacking are longitudinal studies, randomized controlled treatment trials, and studies using ethno-racially diverse samples. Furthermore, there is a need to better understand the interplay between trauma, PTSD, and severe forms of mental illness and to further develop and disseminate evidence-based PTSD treatments in this population. The current state of the literature and future directions for practice are discussed.

Associations between binge and heavy drinking and health behaviors in a nationally representative sample

BACKGROUND Binge and heavy drinking are noted in the literature for their relatively high prevalence and adverse health-related effects. DESIGN AND PARTICIPANTS We used data from the 2006 Behavioral Risk Factor Surveillance Survey (BRFSS) to determine the associations between binge and heavy drinking and a wide range of health-related variables, including positive and negative health behaviors, preventive care practices, and quality of life indices in a nationally representative sample of 344,793 adults. RESULTS Rates of binge and heavy drinking in the current sample were 15% and 5%, respectively. Binge and heavy drinking were more common among men, younger adults, and individuals with higher incomes and at least some college education. After controlling for relevant demographic variables, binge and heavy drinking were associated with a number of adverse health-related and preventive care behaviors (e.g., smoking, failing to receive a mammogram), as well as less life satisfaction and a greater number of poor mental health days than those who did not engage in these drinking behaviors. Interestingly, binge and heavy drinking were also associated with some positive health-related variables (e.g., recent physical activity, positive perceptions of ones own health). CONCLUSIONS The current study findings provide additional information regarding the relations between health-related attitudes and behaviors and binge and heavy drinking in the U.S. population. Implications of study findings are discussed.

Sexual Assault Programming on College Campuses: Using Social Psychological Belief and Behavior Change Principles to Improve Outcomes

Sexual assault programming is often delivered without a theoretical framework and does not typically utilize applicable research that could help to induce change among participants. Such interventions may target male and/or female students, although the focus of this review is on men. It is important to examine these programs in light of current theoretical knowledge and empirical findings from the social psychological attitudinal and behavioral change literatures. To this end, current programming efforts and their limitations are briefly reviewed. Three social psychological theories targeting belief and behavior change (i.e., social norms, hypocrisy salience, decision, and deterrence) are discussed and their application to such programming is elaborated. Given this information, recommendations for the research and practice of such interventions are provided.

Does Encouragement by Others Increase Rape Reporting? Findings From a National Sample of Women

Our study explores the role of victims’ consultation with others about whether or not to report their rape to police. Three groups were observed within this sample of 435 rape victims from a national telephone household probability sample of women: those who did not consult with anyone about reporting (n = 364), those who consulted with someone and were encouraged to report to police (n = 40), and those who consulted with someone and were not encouraged to report (n = 31). Descriptive analyses indicated that the encouraged group was more likely to report to police than either of the other two groups (which did not differ from each other). Because there were no differences between the two consulting groups on demographic or rape-related variables, they were combined in subsequent analyses. Consulting with others about whether to report, peri-traumatic fear of injury or death, assault perpetration by a stranger, and concerns about contracting a sexually transmitted disease were significant predictors of reporting to police after controlling for other significant predictors in a multivariate regression analysis. Implications of these findings are discussed, including the benefits and consequences of formal rape reporting for victims, and the role that disclosure recipients may have in assisting victims postrape (e.g., encouragement of reporting, emotional support).

College Women’s Experiences With Rape Disclosure: A National Study

Disclosure of a rape to informal support sources (e.g., friends) is a relatively common experience, but it is not well understood. This study expands our limited knowledge of the characteristics and life experiences of disclosure recipients among a national sample of 2,000 female college students. Over 40% of respondents reported having received a rape disclosure, and more than two thirds of these recipients encouraged victims to formally report their rapes to the police or other authorities. Correlates of disclosure receipt and encouragement of reporting, including personal assault history, mental health history, and substance use, are presented and discussed.

Promotion of evidence-based practices for child traumatic stress in rural populations: identification of barriers and promising solutions

Child physical abuse, child sexual abuse, and other forms of traumatic stress in childhood are unfortunately quite prevalent. Although most children exhibit striking resiliency in the face of such harrowing experiences, the ubiquity of childhood trauma translates into a significant number of children in need of clinical services to address resultant unremitting distress. Encouragingly, a number of effective interventions for child traumatic stress have been developed in the past several years, and these services are increasingly available in urban areas. Unfortunately, residents of rural and frontier regions may remain underserved despite the existence of effective treatments. This article briefly reviews the prevalence and sequelae of childhood trauma and depicts the numerous barriers to effective treatment faced by rural populations. The authors then briefly review promising evidence-based interventions for child traumatic stress and conclude by enumerating mechanisms for increasing rural populations’ access to these services.

Randomized Controlled Trial of an Internet-Based Intervention Using Random-Digit-Dial Recruitment: The Disaster Recovery Web Project

Disasters occur with high frequency throughout the world and increase risk for development of mental health problems in affected populations. Research focused on the development and evaluation of secondary prevention interventions addressing post-disaster mental health has high potential public-health impact. Toward this end, internet-based interventions (IBIs) are particularly attractive in that they: (1) offer a low-cost means of delivering standardized, targeted, personalized intervention content to a broad audience; and (2) are easily integrated within a stepped care approach to screening and service delivery. We describe a unique study design intended to evaluate an IBI with a disaster-affected population-based sample. Description and rationale are provided for sampling selection and procedures, selection of assessment measures and methods, design of the intervention, and statistical evaluation of critical outcomes. Unique features of this intervention include the use of a population-based sample, telephone and internet-based assessments, and development of a highly individualized web-based intervention. Challenges related to the development and large-scale evaluation of IBIs targeting post-disaster mental health problems, as well as implications for future research and practice are discussed.

Perceptions of, and Assistance Provided to, a Hypothetical Rape Victim: Differences Between Rape Disclosure Recipients and Nonrecipients

Abstract Objective: Undergraduate rape disclosure recipients’ and nonrecipients’ sociodemographic and life experience variables, attitudes towards rape, and responses to a hypothetical rape disclosure were compared to determine differences between them. Participants: One hundred ninety-two undergraduates at 3 universities participated in this online survey between November 2011 and April 2012. Methods: Participants reported on their rape myth acceptance (RMA) and personal direct and indirect (ie, disclosure receipt) experiences with sexual assault. Participants also responded to a hypothetical rape disclosure. Results: Disclosure recipients were more likely to report a victimization history, and less confusion and perceived ineffectiveness in helping the hypothetical victim. RMA and nonrecipient status predicted perceived victim responsibility; these variables and childhood victimization predicted confusion about helping. RMA also predicted perceived ineffectiveness of ones helping behaviors. Victimization history and female gender predicted victim empathy. Conclusions: These findings can inform sexual assault–related programming for undergraduates through the provision of targeted assistance and corrective information.

Technological advances in the treatment of trauma: a review of promising practices.

Given the availability of empirically supported practices for addressing posttraumatic stress disorder and other forms of trauma-related distress, the development and implementation of new technology to deliver these treatments is exciting. Technological innovations in this literature aim to expand availability of empirically based intervention, increase treatment adherence and acceptability, and overcome barriers commonly encountered with conventional trauma-focused treatment. Much of the current research on these technological developments consists of brief reviews and case studies of the separate therapy modalities. Although this work serves to document the appeal and utility of these innovations, it does not provide comprehensive information about the host of options available. To that end, the three general categories of technological advances in trauma therapy (i.e., videoconferencing, e-Health, virtual reality) are reviewed here, including information regarding their empirical support and suggestions for future research and clinical practice.

The Associations between Loss and Posttraumatic Stress and Depressive Symptoms Following Hurricane Ike

UNLABELLED Disasters can have wide-ranging effects on individuals and their communities. Loss of specific resources (e.g., household contents, job) following a disaster has not been well studied, despite the implications for preparedness efforts and postdisaster interventions. OBJECTIVE To provide information about the effects of loss on postdisaster distress, the present study assessed associations between disaster-related variables, including the loss of specific resources, and postdisaster distress. METHOD Random-digit dialing methodology was used to recruit hurricane-affected adults from Galveston and Chambers, TX, counties one year after Hurricane Ike. Data from 1,249 survivors were analyzed to identify predictors of distress. RESULTS Variables that were significantly associated with posttraumatic stress disorder symptoms included sustained losses, hurricane exposure, and sociodemographic characteristics; similar results were obtained for depressive symptoms. CONCLUSIONS Together, these findings suggest risk factors that may be associated with the development of posthurricane distress that can inform preparedness efforts and posthurricane interventions.