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Despite research consistently demonstrating a link between childhood maltreatment and depression, our understanding of the potential mediators of this relationship remains limited. Based on the existing literature and corresponding theories, a theoretical model was constructed to assess the effects of childhood maltreatment, impulsivity, hopelessness, and substance use on adolescent offenders' depression severity. This model was tested for sexual abuse, physical abuse, emotional abuse, and emotional neglect using a series of path analyses. Impulsivity and hopelessness partially mediated the effects of childhood sexual abuse and emotional abuse on depression severity, and fully mediated the effects of childhood physical abuse and emotional neglect. Contrary to expectation, substance use did not mediate the relationship between childhood maltreatment and depression severity. These results suggest that childhood maltreatment, impulsivity, and hopelessness may be important variables to include in clinical research related to depression in incarcerated youth.

BackgroundDifferences in healthcare delivery systems and pathways to mental healthcare for Canadian Armed Forces (CAF) members and Veterans may contribute to variations in mental health services use (MHSU) and the factors associated with it. We: (1) estimated the prevalence of past 12-month MHSU (≥1 visit with a medical or mental health professional); and (2) identified sociodemographic, military-, trauma-, and health-related variables associated with MHSU among CAF members and Veterans.MethodsThe current study used data from the 2018 CAF Members and Veterans Mental Health Follow-Up Survey (CAFVMHS). Model variables were selected a priori, and their respective associations with MHSU were estimated among (1) CAF members and (2) Veterans using separate multivariable logistic regression models.ResultsSimilar proportions of CAF members and Veterans reported past 12-month MHSU (26.9 vs. 27.5%, respectively). For both CAF members and Veterans, meeting criteria for at least one past 12-month MH disorder was associated with past 12-month MHSU [adjusted odds ratio (AOR) = 7.80, 95% confidence interval (CI) = 7.18–8.46; and AOR = 11.82, 95% CI: 11.07–12.61, respectively). Past-year suicide ideation, a history of sexual trauma, and endorsement of adverse childhood experiences were also significantly associated with MHSU among CAF members and Veterans.SignificanceSimilar to previous research, meeting screening criteria for a past 12-month MH disorder was strongly associated with MHSU among both samples. This study extends our existing knowledge about factors associated with MHSU among CAF members and Veterans, and offers direction for future research to increase MHSU.

BackgroundThe role of interpersonal relationship functioning in trauma recovery is well-established. However, much of this research has been done with cross-sectional samples, often years after trauma exposure, using self-report methodology only, and is focused on intimate relationship adjustment.MethodsThe current study investigated the longitudinal associations between interpersonal (intimate and non-intimate) relationship functioning and clinician- and self-reported posttraumatic stress disorder (PTSD) symptoms in 151 recently (within the past 6 months) traumatized individuals. Participants were assessed at four time points over 1 year.ResultsApproximately 53% of the sample was diagnosed with PTSD at initial assessment, with declining rates of diagnostic status over time to 16%. Latent difference score (LDS) modeling revealed nonlinear declines in both clinician-assessed and self-reported PTSD symptom severity, with faster declines in earlier periods. Likewise, LDS models revealed nonlinear declines in negative (conflict) aspects of interpersonal relationship functioning, but linear declines in positive (support, depth) aspects. The relationship between PTSD and relationship functioning differed for clinician- and self-reported PTSD. Bivariate LDS modeling revealed significant cross-lagged effects from relationship conflict to clinician-assessed PTSD, and significant cross-lagged effects from self-reported PTSD to relationship conflict over time.ConclusionsThese results highlight that the variability in prior results may be related to the method of assessing PTSD symptomatology and different relational constructs. Implications for theory and early intervention are discussed.

Posttraumatic stress disorder (PTSD) and substance use disorder (SUD) commonly cooccur following trauma, and their co-occurrence is associated with substantial costs; however, our understanding of the timing and sequencing of these posttrauma mental health conditions is limited. This study examined the trajectories of PTSD symptom severity and substance use among individuals recently exposed to a traumatic event, with a focus on the potential moderating roles of PTSD and SUD diagnoses at the final assessment. Additionally, in attempt to better understand the functional relationship between PTSD symptoms and substance use posttrauma, this study compared models reflecting the theories of self-medication, susceptibility, and mutual maintenance. Participants included 137 individuals who had experienced a traumatic event within 6 months prior to study enrollment. Participants completed four assessments over an approximate 1-year period that included clinician-administered measures for DSM-5 PTSD symptoms and SUD diagnosis and self-report measures of alcohol and drug use. Change over time in PTSD symptoms and substance use by diagnostic status were investigated using growth curve models. Temporal sequencing between PTSD symptom severity and substance use was investigated with bivariate latent difference score structural equation modeling. In line with the conceptualization of PTSD as a disorder of impeded recovery, having a diagnosis of PTSD at the final assessment moderated the trajectory of PTSD symptom severity such that symptom severity declined only among those without PTSD. In contrast, the influence of SUD appeared to be negligible. Both PTSD and SUD diagnoses were associated with initial drug use frequency. However, the relationship between alcohol use and diagnostic status did not reach statistical significance. Regarding temporal relationships between PTSD symptoms and substance use, significant and negative PTSD to change in substance use cross-lagged paths were found across most of the models, while only one significant substance use to change in PTSD severity crosslagged path emerged in the PTSD intrusion with alcohol use model. These results add to a growing body of research suggesting trauma-focused intervention is viable for individuals with PTSD/SUD. Further, examination of potential mediators and moderators of the relation between PTSD and SUD is recommended as a critical focus for future research.

Although multisource assessment of posttraumatic stress disorder (PTSD) is considered best practice, past studies have either compared convergence between clinician interview and self-report or self- and close other collateral report of PTSD symptoms without clinician interview. Familial and interpersonal relationships are consistently found to be associated with an individual's psychological recovery following a traumatic event. Thus, it is important to understand the extent to which close others' collateral reports converge with clinician and self-reports of PTSD. This study compared self-, collateral, and clinician reports of PTSD symptom severity. Recently trauma-exposed individuals (N = 117) were assessed using the Clinician-Administered PTSD Scale (CAPS; Blake et al., 1995) and completed the past-month PTSD Checklist-Specific Stressor (PCL; Weathers, Litz, Herman, Huska, & Keane, 1993). Close others (N = 117) completed the PCL for close others (PCL-CO; Monson, 2012) that assessed their perceptions of the trauma-exposed individual's PTSD symptoms. There were significant positive correlations among PCL, PCL-CO, and CAPS total and symptom cluster scores (rs = .36-.80). Correlations were significantly stronger between clinician and self-report ratings than self-report and collateral ratings. The weakest correlations were between the PCL and PCL-CO assessing hyperarousal symptoms, r = .36, p < .01, and CAPS and PCL-CO assessing intrusive symptoms, r = .37, p < .01. Self-report measures may provide reliable PTSD assessment when clinician semistructured assessment is unfeasible. Convergence between close others' collateral and clinician and collateral and self-assessment was comparatively weak. Hyperarousal and intrusive symptoms may be more difficult for collaterals to observe and report. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Posttraumatic stress disorder (PTSD) and substance use disorder (SUD) commonly co-occur. Emerging research suggests that both distress tolerance and impulsivity may underlie this comorbidity. However, to our knowledge no studies have examined whether these 2 constructs predict outcome in PTSD-SUD treatment. The current study investigated whether pretreatment distress tolerance and impulsivity predicted posttreatment PTSD and cravings severity in a sample of 70 Veterans receiving concurrent treatment for PTSD and SUD in a residential day treatment program. Veterans completed measures of symptom severity before and after treatment. Results demonstrated that pretreatment distress tolerance predicted posttreatment PTSD severity while controlling for pretreatment PTSD. By contrast, pretreatment impulsivity was not predictive of posttreatment PTSD while controlling for pretreatment values. Neither distress tolerance nor impulsivity predicted posttreatment cravings severity. The findings support the noti...

Posttraumatic stress disorder (PTSD) and substance use disorders (SUDs) commonly co-occur, and there is some evidence to suggest that PTSD symptom clusters are differentially related to various substances of abuse. However, few studies to date have compared PTSD symptom patterns across people with different types of SUDs, and fewer still have accounted for the presence of comorbidity across types of SUDs in understanding symptom patterns. Thus, in the current study, we use a treatment-seeking sample of people with elevated symptoms of PTSD and problem alcohol use to explore differential associations between past-year SUDs with active use and PTSD symptoms, while accounting for the presence of multiple SUDs. When comparing alcohol and drug use disorders, avoidance symptoms were elevated in those with alcohol use disorder, and hyperarousal symptoms were elevated in those who had a drug use disorder. In the subsample with alcohol use disorder, hyperarousal symptoms were elevated in people with co-occurring cocaine use disorders and numbing symptoms were elevated in people with co-occurring sedative/hypnotic/anxiolytic use disorder. These findings provide evidence for different symptom cluster patterns between PTSD and various types of SUDs and highlight the importance of examining the functional relationship between specific substances of abuse when understanding the interplay between PTSD and SUDs.

The current study examined the effect of total, as well as different sources (i.e., family, friends, significant other) of, pretreatment/baseline social support on posttraumatic stress disorder (PTSD) severity and treatment response to cognitive-behavioral conjoint therapy (CBCT) for PTSD. Thirty-six patients were randomized to receive treatment immediately or to a waitlist condition. Those in the treatment condition were offered CBCT for PTSD, a couple-based therapy aimed at reducing PTSD symptoms and improving relationship functioning. PTSD symptoms were assessed at pre-/baseline, mid-/4 weeks of waiting, and posttreatment/12 weeks of waiting using the Clinician-Administered PTSD Scale, and patients self-reported on their levels of pretreatment/baseline social support using the Multidimensional Scale of Perceived Social Support. Total support, as well as social support from family and friends, was not associated with initial PTSD severity or treatment response. However, there was a significant positive association between social support from a significant other and initial PTSD severity (g = .92). Additionally, significant other social support moderated treatment outcomes, such that higher initial significant other support was associated with larger decreases in PTSD severity for those in the treatment condition (g = -1.14) but not the waitlist condition (g = -.04). Social support from a significant other may influence PTSD treatment outcomes within couple therapy for PTSD. The inclusion of intimate partners and other family members may be a fruitful avenue for improving PTSD treatment outcomes; however, future studies are needed to examine whether support can be increased with treatment and whether those improvements lead to greater PTSD symptom response.

Background Posttraumatic stress disorder (PTSD) and substance use disorder (SUD) are prevalent and pernicious disorders that are commonly comorbid. Though promising findings have been documented for psychotherapies addressing PTSD/SUD, this is a relatively new area of inquiry.

Objective The efficacy of a present-focused version of cognitive-behavioral conjoint therapy for posttraumatic stress disorder (CBCT for PTSD) was examined in a community sample. Method Seven couples completed pretreatment assessments, including measures of clinician-, self- and partner-rated PTSD symptoms and relationship satisfaction. Six couples completed present-focused CBCT for PTSD and all posttreatment assessments. A seventh couple terminated their relationship prior to completing treatment; therefore, they completed posttreatment symptom measures, but not ratings of relationship satisfaction. Results Results revealed significant decreases in PTSD symptoms that were associated with medium-to-large effect sizes. Medium effect sizes for changes in relationship satisfaction were found, though were only significant for partners. Conclusion Results from this pilot study suggest that present-focused CBCT for PTSD may be a promising alternative for individuals who are unwilling to engage in a trauma-focused treatment.

This randomized controlled hybrid implementation/effectiveness trial aimed to compare the impact of three different models of training and consultation by examining the PTSD treatment outcomes achieved by therapists who were learning a front-line recommended psychotherapy for posttraumatic stress disorder (PTSD), Cognitive Processing Therapy (CPT; Resick, Monson, & Chard, 2017). Therapists (N = 134) were randomized into one of three conditions after attending a standard CPT training workshop: No Consultation with delayed feedback on CPT fidelity, Standard Consultation involving discussion and conceptualization of cases without session audio review, and Consultation Including Audio Review, which included a review of segments of audiorecorded CPT sessions. Across all training conditions, the patients treated by these therapists (N = 188) evidenced statistically significant reductions in PTSD symptoms, (d = −0.95 to −1.78), comorbid symptoms and functioning (d = −0.27 to −0.51). However, patients of therapists in the Standard Consultation condition (ΔPTSD = - 19.64, d = −1.78) experienced significantly greater improvement than those in the No Consultation condition (ΔPTSD = - 10.54, d = −0.95, ΔDEV = 6.30, ΔParms = 2, p = .043). This study demonstrates that patients who receive evidence-based psychotherapy for PTSD in routine care settings can experience significant symptom improvement. Our findings also suggest that to maximize patient benefit, therapist training should include consultation, but that audio review of sessions during consultation may not be necessary, at least for structured protocols. Implications for implementation, including the reduction of burden and cost of post-workshop support, are discussed.

The continuity of developmental risk factors from childhood into adolescence to predict criminal adult offending has not been investigated. From a developmental and life-course perspective, the issue is of both theoretical and practical importance, as understanding the long-term impact of early life experiences on adult outcomes that carry forward across major developmental periods can assist clinicians with the identification of targets for early intervention and prevention. The aim of the present study was to examine the extent to which childhood and adolescent risk factors distinguish among three offender subgroups in a sample of adult male offenders. The results indicated that the groups were more clearly distinguished on adolescent risk factors, giving greater prominence to proximal than distal predictors. As well, from a dose-response perspective, the pure sex offenders showed the most adverse developmental history and were differentiated from both the versatile violent sex offenders and the...

Objective: The purpose of this study was to determine whether anger and jealousy mediate the relationship between adult attachment styles (i.e., dismissive, fearful, preoccupied, secure) and physical intimate partner violence (IPV) perpetration for both men and women. Method: Undergraduate students (n = 431) were sampled from a large Midwestern U.S. university. Results: Mediational analyses revealed that anger mediated the associations between each of the four attachment styles and violence perpetration for women. However, neither anger nor jealousy mediated the association between attachment and violence perpetration for men. Conclusions: Young women’s IPV perpetration appears more closely related to their emotional responses, in particular anger, but violence perpetration in young men does not necessarily seem to follow this pattern. These findings suggest specific strategies which may be useful for preventive efforts of violence perpetration in young adult women, such as anger-related emotion regulation skills training.

The study of risk factors for antisocial and delinquent behavior has flourished in the past 20 years, as great strides have been made in understanding the developmental pathways that give rise to the onset, course, and desistance of the behavior. However, as a body of literature, risk factor research (RFR) is characterized by heterogeneity in definitions, conceptualization, and measurement of key constructs that can make it difficult to discern robust from spurious findings. This may pose challenges to child-serving agencies invested in developing crime reduction policies and programs but lack the resources to carefully comb through and make sense of the literature. This article reviews the terminological, conceptual, and methodological issues in the RFR literature with an aim towards clarifying some of the inconsistencies that limit interpretation and application of findings. Risk factors related to antisocial and delinquent behavior are used to illustrate the concepts discussed. We reviewed the RFR literature pertaining to antisocial and delinquent behavior in children and youth to identify key concepts and discrepancies in this area. The literature would be well served if researchers were consistent in their use of terminology to describe the effects of risk factors on antisocial and delinquent behavior. There is also a need to study the processes and causal mechanisms that link past events to future outcomes.

Posttraumatic stress disorder (PTSD) and substance use disorders (SUDs) are commonly co-occurring disorders associated with more adverse consequences than PTSD alone. Prolonged exposure therapy (PE) is one of the most efficacious treatments for PTSD. However, among individuals with PTSD-SUD, 35-62% of individuals drop out of trauma-focused exposure treatments. Thus, it is important to identify predictors of PTSD treatment dropout among substance abusers with PTSD in order to gain information about adapting treatment strategies to enhance retention and outcomes. The current study explored pre-treatment predictors of early termination from PE treatment in a sample of 85 individuals receiving concurrent treatment for PTSD and a SUD in a residential treatment facility as part of a randomized controlled trial. The results indicated that less education and more anxiety sensitivity uniquely predicted PE treatment dropout. Demographic variables, PTSD severity, SUD severity, mental health comorbidities, and emotion regulation difficulties did not predict treatment dropout. These results suggest that adding pre-treatment interventions that address anxiety sensitivity, and promote social adjustment and cognitive flexibility, could possibly improve PE retention rates in clients with high anxiety or low education.

Social functioning is negatively impacted by the presence of PTSD, while increasing risk of suicidal behavior among individuals with PTSD. However, little research has examined the specific role of social functioning in the association between PTSD and suicidal behavior. Parallel multiple indirect effects analyses were performed to understand the unique indirect effects of four aspects of social functioning. Indirect effects of PTSD on suicidal ideation were significant through three pathways: interpersonal conflict, perceived family support, and interpersonal apprehension. Perceived family support was the only indirect pathway significantly associated with suicide attempt. Findings suggest that social functioning should be assessed and potentially targeted during treatment to help modify the risk for suicidal behavior among individuals with PTSD.

Cognitive-behavioral conjoint therapy for posttraumatic stress disorder (CBCT for PTSD) is designed to improve PTSD symptoms and enhance intimate relationship adjustment. Phase 1 includes psychoeducation about the reciprocal influences of PTSD symptoms and relationship functioning, exercises to promote positive affect and behaviors, and conflict management skills. In Phase 2, behavioral methods are used to address avoidance and emotional numbing and to increase relationship satisfaction. Couples engage in activities to promote approaching, rather than avoiding, feared situations. Phase 3 focuses on specific trauma appraisals and here-and-now cognitions that maintain PTSD and relationship problems. This article provides an overview of the treatment, a review of the outcome research, and a case illustration of a couple with a shared trauma (a stillborn child).

Understanding the developmental precursors of juvenile violent sex offending can contribute to the promotion of effective early intervention and prevention programs for high-risk children and youth. However, there is currently a lack of research on the early characteristics of adolescents who commit violent sex offenses. Drawing on the literature regarding the generalist and specialist positions of criminal behavior, the aim of the present study was to compare childhood risk factors for three groups of juvenile offenders: (a) pure sex offenders (PSO; n = 28); (b) violent non-sex offenders (VNSO; n = 172); and (c) versatile violent sex offenders (VVSO; n = 24). Nineteen risk factors comprising four life domains (individual, family, peer, and school) were identified from a file review. Three hierarchical logistic regression analyses examined associations between risk factors and offender groups. The results reflected the underlying heterogeneity of the sample, offering support for both the specialist and generalist positions of criminal behavior. PSOs differed from VNSOs on the basis of higher odds for precocious sexual behavior. Second, VVSOs differed from VNSOs on the basis of higher odds for precocious sexual behavior, criminal family members, and an adolescent mother, as well as lower odds for poor school behavior. Third, PSOs were marginally more likely to have engaged in early overt antisocial behavior compared with VVSOs. Fourth, many of the childhood risk factors examined were not associated with any offender group. In conclusion, VVSOs appeared to differ on the greatest number of risk factors from VNSOs, suggesting that VVSOs share a more similar developmental pathway with PSOs. The prevention and future research implications of these findings are discussed.

The efficacy of a present-focused version of cognitive-behavioral conjoint therapy for posttraumatic stress disorder (CBCT for PTSD) was examined in a community sample.Seven couples completed pretreatment assessments, including measures of clinician-, self- and partner-rated PTSD symptoms and relationship satisfaction. Six couples completed present-focused CBCT for PTSD and all posttreatment assessments. A seventh couple terminated their relationship prior to completing treatment; therefore, they completed posttreatment symptom measures, but not ratings of relationship satisfaction.Results revealed significant decreases in PTSD symptoms that were associated with medium-to-large effect sizes. Medium effect sizes for changes in relationship satisfaction were found, though were only significant for partners.Results from this pilot study suggest that present-focused CBCT for PTSD may be a promising alternative for individuals who are unwilling to engage in a trauma-focused treatment.

Youth involved in the juvenile justice system are at high risk for mental health problems, particularly depression. Furthermore, these youth often present with a history of childhood maltreatment. Despite research consistently demonstrating a link between childhood maltreatment and depression, our understanding of intervening factors of this relationship remains limited. This study examined impulsivity, hopelessness, and substance use as potential explanatory variables in the relationship between cumulative childhood maltreatment and depression severity among 110 incarcerated youth. The data were analyzed using path analysis. As hypothesized, cumulative maltreatment maintained a strong direct relation with depression severity in the context of the additional variables in the final model. Cumulative maltreatment also had an indirect relation with depression severity through both impulsivity and hopelessness. Contrary to expectation, substance use was not an explanatory variable in the model. These findings suggest that impulsivity and hopelessness might be important factors to consider in future studies on the relation between childhood maltreatment and depression symptoms among incarcerated youth.

Juvenile offenders are at risk for involvement in both fighting behavior and peer victimization. Understanding the potential causal mechanisms leading to these outcomes is important to address the needs of this population. The present study tested four mediator models of violent perpetration and peer victimization in a sample of 112 incarcerated youth (68 males and 44 females). In the models, the relationship between child physical and emotional abuse and fighting and victimization was expected to be mediated by impulsiveness, depression, and drug use. Multiple mediator models were tested according to Preacher and Hayes (2008). Depression fully mediated the relation between child emotional abuse and victimization and partially mediated the relation between child physical abuse and victimization. Drug use fully mediated the relation between child emotional abuse and fighting. These results suggest that treatment of depressive symptoms and drug use among juvenile offenders with a history of child physical or emotional abuse may limit violent perpetration and peer victimization in this population. (PsycINFO Database Record (c) 2012 APA, all rights reserved). Language: en