Natalie R. Stevens

Emotion regulation difficulties, low social support, and interpersonal violence mediate the link between childhood abuse and posttraumatic stress symptoms

We examined how difficulties with emotion regulation, social support, and interpersonal violence in adult relationships mediated the relationship between childhood abuse and post traumatic symptoms (PTS) in adults. We fit a multiple mediation model to data from 139 socio-economically disadvantaged women (85% African American) of whom 44% endorsed moderate to severe levels of childhood physical, sexual, or emotional abuse and 12% screened positive for probable posttraumatic stress disorder (PTSD). The model accounted for 63% of the variance in adult PTS symptoms. Child abuse exerted a direct effect on PTS symptoms and indirect effects through difficulties with emotion regulation, lower social support, and greater exposure to adult interpersonal violence. Implications of findings for the treatment of individuals at high risk of having experienced childhood abuse and PTS are discussed.

Insomnia and Well-Being

Most Americans have occasional problems with insomnia. The relationship of insomnia to illness is well known. However, insomnia may also relate to lower levels of well-being. Although there are various definitions of well-being, one of the most clearly articulated and comprehensive models identifies 2 overarching constructs, psychological well-being and subjective well-being. The purpose in the present study was to assess the relationship between insomnia symptoms and the dimensions of psychological and subjective well-being, adjusting for the potential confound of comorbid physical and psychological illness. The data for the present study came from the National Survey of Midlife Development in the United States, a survey of community-dwelling adults. After adjustment for demographic characteristics and a wide range of chronic mental and physical health conditions, insomnia symptoms were found to have a significant relationship with both psychological and subjective well-being but a stronger relationship to subjective well-being. These data suggest that insomnia symptoms have a stronger relationship to enjoying life than to the perception that one has a meaningful life.

Interpersonal violence, PTSD, and inflammation: potential psychogenic pathways to higher C-reactive protein levels.

Interpersonal violence (IPV) is major public health concern with wide-ranging sequelae including depression, posttraumatic stress disorder (PTSD), and possible alterations of immune and inflammation processes. There is a need to identify the psycho-biological pathways through which IPV may translate to altered inflammatory processes since both PTSD and inflammation are associated with serious physical health conditions such as obesity, diabetes, and cardiovascular disease. This study investigated the relationships between IPV, psychological distress, and the inflammatory marker C-reactive protein (CRP), in a sample of 139 urban women who have a high likelihood for having experienced IPV. Participants were recruited from an outpatient gynecology clinic to complete self-report measures about their IPV histories and psychological symptoms, as well as to have their blood sampled using a finger stick. Results indicated that exposure to IPV predicted the presence of probable depression and PTSD diagnoses. Individuals who experience clinical levels of PTSD exhibited higher CRP levels, and this relationship held after adjusting for comorbid depression. Correlational analyses suggested that reexperiencing symptoms may explain the link between PTSD diagnosis and higher levels of CRP. Follow-up path analytic models provided good fit to the overall data, and indicated that the relationship between probable PTSD status and CRP is not explained by higher BMI. Overall, these findings call for increased attention to the role of PTSD in explaining links between trauma and diminished health.

Expanding the Science of Resilience: Conserving Resources in the Aid of Adaptation.

In considering resilience to stress there are several key organizing principles that will aid both research and understanding. Understanding resilience is critical to illumination of the stress process, be it for purposes of research, policy, or intervention. Bonanno, Romero, and Klein (this issue) provide an excellent review of thinking on resilience and delineate several key foci that require future attention. In particular, Bonanno et al. (this issue) aid the study and understanding of resilience by outlining the temporal elements of resilience. They also insightfully push the focus of resilience beyond just the individual level, to the level of the family and community. In their paper, they state that their “elemental approach provides a ready framework for integrating the various meanings of psychological resilience into a single unfolding process.” What we think can further guide this field is the introduction of several key constructs that help describe key organizing principles about resilience that map out the critical constructs and processes that characterize resilience. To be clear, many of these concepts have been discussed in some form by Bonanno in his seminal work on resilience (Bonanno, 2004; 2005; Bonanno, Galea, Bucciarelli, & Vlahov, 2006; Bonanno, Brewin, Kaniasty & La Greca, 2010), or have been spurred on our part by considering his thoughts and studies of resilience carefully (Hobfoll, 2011). However, we think we have mined, refined, and polished some of the ideas in a way that may further contribute to the field. Together with the contributions of Bonanno et al. (this issue), these might aid the advancement of knowledge on withstanding major and traumatic stressors and recovery in the face of major and traumatic stressors.

The Assessment of Emotion Regulation in Cognitive Context: The Emotion Amplification and Reduction Scales

The purpose of this study was to provide initial psychometric evidence for the reliability and validity of The Emotion Amplification and Reduction Scales (TEARS), a questionnaire designed to assess perceived ability to change the trajectory of an emotional response. Items were formulated to assess perceived ability to amplify an emotionally response by either prolonging or intensifying an existing emotion. Additional items were selected to measure processes related to emotion reduction, selecting an emotional response or altering an existing emotion by softening, stopping, or shortening it. Both subscales, Emotion Amplification and Emotion Reduction, were found to have good internal consistency. Confirmatory Factor Analysis was used to document the two-factor structure of the measure and to assess evidence for construct validity. The latent Emotion Reduction variable was found to correlate inversely with negative affect and symptoms of depression. The latent Emotion Amplification variable was found to correlate with higher positive affect and also fatigue. As expected, TEARS is correlated with tonic measures of emotionality.

Perceived control and maternal satisfaction with childbirth: a measure development study.

The purpose of this study was to develop and validate two instruments: one to assess patient perceptions of control of the childbirth environment and the other, global satisfaction with the childbirth experience. Participants were 187 women recruited from obstetric clinics, breast-feeding support groups and online who had given birth in the past 4 months. Scale development involved item construction, exploratory factor analysis (EFA) of the Perceived Control in Childbirth Scale (PCCh), confirmatory factor analysis (CFA) of the Satisfaction with Childbirth Scale (SWCh), reliability analysis and construct validity analyses. EFA identified a single factor underlying a set of items reflecting the patient’s belief that her actions influenced the birth environment (i.e. perceived control). CFAs supported a single-factor model reflecting the degree to which the birth experience met the patient’s ideal (i.e. satisfaction). Perceived control was associated with childbirth self-efficacy. Childbirth satisfaction was associated with both affective reactions to birth and childbirth-related posttraumatic stress disorder (PTSD) symptoms. Results support the validity and reliability of two new scales that assess perceived control of the birth environment and global satisfaction with childbirth.

Validation of the multidimensional health locus of control scales for labor and delivery

No current instrument assesses womens health locus of control beliefs in relation to childbirth. Form C of the Multidimensional Health Locus of Control Scales was used to develop items for a new instrument specific to labor and delivery (MHLC-LD). Psychometric analyses conducted with two independent samples of pregnant women supported a three-factor model of the new instrument, consisting of Internal, Powerful Others, and Chance subscales. Results revealed modest coefficient alphas (>.70) for the subscales and demonstrated construct validity in known group analyses. Future validation research will focus on improving the internal consistency reliability of the MHLC-LD, testing factorial invariance across demographic groups, and examining the relationships between obstetric risk, previous birth experiences, and beliefs about control over childbirth outcomes.

Vets prevail online intervention reduces PTSD and depression in veterans with mild-to-moderate symptoms.

OBJECTIVE Despite heightened rates of depression and posttraumatic stress disorder (PTSD) among in Iraq/Afghanistan veterans, the majority of distressed veterans will not receive mental health care. Overcoming barriers to mental health services requires innovative approaches to broaden the reach of evidence-based treatment. The current study examined the efficacy and acceptability of an innovative and dynamic online cognitive-behavioral therapy intervention for PTSD and depression called Vets Prevail. METHOD A randomized clinical trial conducted between 2011 and 2013 assessed changes in PTSD and depression in veterans with mild-to-moderate distress. Veterans randomized to Vets Prevail (n = 209) were aged 34.2 ± 7.6 years, mostly male (81.3%), and nonminority (73.7%). Veterans randomized to adjustment as usual (n = 94) were aged 34.7 ± 8.9, mostly male (81.9%), and White (67.0%). Veterans completed the PTSD Checklist-Military Version and the Center for Epidemiological Studies Depression scale (10-item version) postintervention and at 12-week follow-up. RESULTS Veterans in the Vets Prevail condition reported significantly greater reductions in PTSD, t(250) = 3.24, p = .001 (Mreduction = 5.51, SD = 9.63), and depression, t(252) = 4.37, p = .001 (Mreduction = 2.31, SD = 5.34), at 12-week follow-up compared with veterans in the adjustment as usual condition (PTSD Mreduction = 1.00, SD = 7.32; depression Mreduction = 0.48, SD = 4.95), with moderate effect sizes for PTSD (Cohens d = 0.42) and depression (Cohens d = 0.56). Exploratory analysis shows that Vets Prevail may be effective regardless of combat trauma exposure, gender, and ethnic minority status. CONCLUSION Vets Prevail circumvents many barriers to care and effectively addresses the dire mental health needs of veterans.

Depression, Fatigue, and Pre-Sleep Arousal: A Mediation Model

Fatigue is a common and debilitating symptom of clinical depression; however, the causes are not well understood. The present study was designed to test the hypotheses that subjective sleep, objective sleep, and arousal in the pre-sleep state would mediate the relationship between depression status and fatigue. Sleep, pre-sleep arousal, and fatigue were assessed in 21 depressed and 37 never-depressed undergraduates. Results showed that pre-sleep arousal was a significant partial mediator of the relationship between depression status and fatigue. These results indicate that arousal in the pre-sleep state deserves further attention as a potential antecedent to fatigue in clinically depressed undergraduates.

Examining the effectiveness of a coordinated perinatal mental health care model using an intersectional-feminist perspective

Untreated perinatal depression and anxiety are significant public health problems that disproportionately affect ethno-racial minorities. The purpose of this study was to examine the effectiveness of a coordinated perinatal mental health care model, focusing on socially-disadvantaged, ethno-racial minority women, with an intersectional-feminist perspective. The treatment model was grounded in intersectionality theory with the aim of addressing complex social vulnerability factors in the context of perinatal mental health treatment. Participants were 67 perinatal women (64% African American or Hispanic/Latina) referred by medical providers at an urban teaching hospital. Results demonstrated high treatment engagement and effectiveness, with 65.9% of participants demonstrating reliable improvement in symptoms. Moreover, African American and Hispanic/Latina patients had similar treatment outcomes compared to White patients, despite facing greater socio-economic disadvantages. Findings indicate that the treatment model may be a promising approach to reducing perinatal mental health disparities. Strengths and limitations of the study are discussed within the intersectionality framework.