Ron Acierno

Violence and Risk of PTSD, Major Depression, Substance Abuse/Dependence, and Comorbidity: Results From the National Survey of Adolescents

With a national household probability sample of 4,023 telephone-interviewed adolescents ages 12-17, this study provides prevalence, comorbidity, and risk-factor data for posttraumatic stress disorder (PTSD), major depressive episode (MDE), and substance abuse/dependence (SA/D). Roughly 16% of boys and 19% of girls met criteria for at least 1 diagnosis. Six-month PTSD prevalence was 3.7% for boys and 6.3% for girls, 6-month MDE prevalence was 7.4% for boys and 13.9% for girls, and 12-month SA/D prevalence was 8.2% for boys and 6.2% for girls. PTSD was more likely to be comorbid than were MDE and SA/D. Results generally support the hypothesis that exposure to interpersonal violence (i.e., physical assault, sexual assault, or witnessed violence) increases the risk of these disorders and of diagnostic comorbidity.

Prevalence and correlates of emotional, physical, sexual, and financial abuse and potential neglect in the United States: the National Elder Mistreatment Study

OBJECTIVES We estimated prevalence and assessed correlates of emotional, physical, sexual, and financial mistreatment and potential neglect (defined as an identified need for assistance that no one was actively addressing) of adults aged 60 years or older in a randomly selected national sample. METHODS We compiled a representative sample by random digit dialing across geographic strata. We used computer-assisted telephone interviewing to standardize collection of demographic, risk factor, and mistreatment data. We subjected prevalence estimates and mistreatment correlates to logistic regression. RESULTS We analyzed data from 5777 respondents. One-year prevalence was 4.6% for emotional abuse, 1.6% for physical abuse, 0.6% for sexual abuse, 5.1% for potential neglect, and 5.2% for current financial abuse by a family member. One in 10 respondents reported emotional, physical, or sexual mistreatment or potential neglect in the past year. The most consistent correlates of mistreatment across abuse types were low social support and previous traumatic event exposure. CONCLUSIONS Our data showed that abuse of the elderly is prevalent. Addressing low social support with preventive interventions could have significant public health implications.

Health Impact of Interpersonal Violence 2: Medical and Mental Health Outcomes

(1997). Health Impact of Interpersonal Violence 2: Medical and Mental Health Outcomes. Behavioral Medicine: Vol. 23, No. 2, pp. 65-78.

Risk Factors for Rape, Physical Assault, and Posttraumatic Stress Disorder in Women: Examination of Differential Multivariate Relationships

The National Womens Study, a 2-year, three-wave longitudinal investigation, employed a national probability sample of 3,006 adult women to: (a) identify separate risk factors for rape and physical assault, and (b) identify separate risk factors associated with post-rape posttraumatic stress disorder (PTSD) and post-physical assault PTSD. This investigation differed from previous studies in that it prospectively examined risk factors at the multivariate, as opposed to univariate level. Overall, past victimization, young age, and a diagnosis of active PTSD increased womens risk of being raped. By contrast, past victimization, minority ethnic status, active depression, and drug use were associated with increased risk of being physically assaulted. Risk factors for PTSD following rape included a history of depression, alcohol abuse, or experienced injury during the rape. However, risk factors for PTSD following physical assault included only a history of depression and lower education.

Mental Health Needs of Crime Victims: Epidemiology and Outcomes

This paper reviews epidemiological estimates of criminal victimization derived largely from nationally based studies in the United States. Origins of conflicting rates and prevalences are explained in terms of varying methodology. Risk factors for victimization, including age, race, gender, and disability, are also outlined, and derived from both national and geographically limited U.S.-based studies. Finally, mental health outcomes of violence are documented, with conclusions drawing on both national and regionally specific studies. These outcomes focus on posttraumatic stress disorder, but also include depression, substance abuse, and panic.

Ten year revision of the brief behavioral activation treatment for depression: Revised treatment manual

Following from the seminal work of Ferster, Lewinsohn, and Jacobson, as well as theory and research on the Matching Law, Lejuez, Hopko, LePage, Hopko, and McNeil developed a reinforcement-based depression treatment that was brief, uncomplicated, and tied closely to behavioral theory. They called this treatment the brief behavioral activation treatment for depression (BATD), and the original manual was published in this journal. The current manuscript is a revised manual (BATD-R), reflecting key modifications that simplify and clarify key treatment elements, procedures, and treatment forms. Specific modifications include (a) greater emphasis on treatment rationale, including therapeutic alliance; (b) greater clarity regarding life areas, values, and activities; (c) simplified (and fewer) treatment forms; (d) enhanced procedural details, including troubleshooting and concept reviews; and (e) availability of a modified Daily Monitoring Form to accommodate low literacy patients. Following the presentation of the manual, the authors conclude with a discussion of the key barriers in greater depth, including strategies for addressing these barriers.

Health Impact of Interpersonal Violence 1: Prevalence Rates, Case Identification, and Risk Factors for Sexual Assault, Physical Assault, and Domestic Violence in Men and Women

This integrated series of three articles deals with the relationship between interpersonal violence and health. In the first article, the scope of the problem, the prevalence of interpersonal violence, and information on rates of violent crime in specific subgroups of people are outlined. The role of the treating physician and other health professionals in failing to identify cases of assault-related illness is considered, as are the factors that place individuals at increased risk of assault. In the second article, the impact of interpersonal violence on physical and mental health is reviewed, and the results of basic and applied clinical research into acute and chronic emotional and physical sequalae are discussed. The third article includes an outline of implications for research, training, and clinical practice using behavioral techniques in treating victims of interpersonal violence.

Assault, PTSD, family substance use, and depression as risk factors for cigarette use in youth: findings from the National Survey of Adolescents.

A national household probability sample of 4,023 adolescents aged 12 to 17 years was surveyed by telephone via structured clinical interview to determine the impact of familial substance use, sexual and physical assault, witnessed violence, depression and posttraumatic stress disorder (PTSD) on risk of smoking. Results indicated that familial substance use increased risk of smoking only for boys and sexual assault or depression increased risk of smoking only for girls. Age, Caucasian ethnicity, and experiencing physical assault or witnessing violence elevated risk of current cigarette use for both genders. By contrast, PTSD per se was not associated with increased risk of smoking, after the effects of other variables were controlled.

A pilot study of prolonged exposure therapy for posttraumatic stress disorder delivered via telehealth technology

The authors present a pilot study of 12 veterans diagnosed with combat-related PTSD and treated with prolonged exposure therapy (PE) via telehealth technology. A reference sample of 35 combat veterans treated with in-person PE in the same clinic is also included for a comparison. Feasibility and clinical outcomes of interest include technical performance and practicality of the telehealth equipment, patient safety, treatment completion rates, number of sessions required for termination, and clinical outcomes. Results indicated large statistically significant decreases in self-reported pathology for veterans treated with PE via telehealth technology. Preliminary results support the feasibility and safety of the modality. Suggestions for the implementation of PE via telehealth technology are discussed.

Psychological sequelae resulting from the 2004 Florida hurricanes: implications for postdisaster intervention.

OBJECTIVES Data are limited regarding mental health effects of disasters such as hurricanes. We sought to determine the prevalence of and major risk factors associated with posttraumatic stress disorder (PTSD), generalized anxiety disorder, and major depressive episode 6 to 9 months after the 2004 Florida hurricanes. METHODS Random-digit dialing was used to recruit a representative population sample of 1452 hurricane-affected adults. RESULTS Posthurricane prevalence for PTSD was 3.6%, for generalized anxiety disorder was 5.5%, and for major depressive episode was 6.1%. Risk factors varied somewhat across disorders, with the exception of previous exposure to traumatic events, which increased risk of all negative outcomes. CONCLUSIONS Storm exposure variables and displacement were associated primarily with PTSD. Notably, high social support in the 6 months preceding the hurricanes protected against all types of disorders.