Search

Here we report the isolation of a murine model for heritable T cell lymphoblastic leukemia/lymphoma (T-ALL) called Spontaneous dominant leukemia (Sdl). Sdl heterozygous mice develop disease with a short latency and high penetrance, while mice homozygous fo

Published findings are mixed regarding the underlying factor structure of the PTSD Checklist (PCL). Studies have found two-, three-, and four-factor solutions, which are only partially consistent with DSM-IV-defined PTSD symptom clusters (reexperiencing, avoidance, and hyperarousal). The current study examined the reliability, validity, and factor structure of the PCL in a sample of dually diagnosed (substance use disorder and other psychiatric disorder) participants living with HIV/AIDS. Results supported the robust psychometric properties of the PCL, with high reliability and validity. Using confirmatory factor analysis, two models, a second-order (two-factor) and a first-order (fourfactor) solution were supported. The utility of the PCL and implications for the dimensionality of PTSD in this population are discussed. [ABSTRACT FROM AUTHOR]

Chronic pain and post-traumatic stress disorder (PTSD) are frequently observed within the Department of Veterans Affairs healthcare system and are often associated with a significant level of affective distress and physical disability. Clinical practice and research suggest that these two conditions co-occur at a high rate and may interact in such a way as to negatively impact the course of either disorder; however, relatively little research has been conducted in this area. This review summarizes the current literature pertaining to the prevalence and development of chronic pain and PTSD. Research describing the comorbidity of both conditions is reviewed, and several theoretical models are presented to explain the mechanisms by which these two disorders may be maintained. Future directions for research and clinical implications are discussed. [ABSTRACT FROM AUTHOR]

This study examined the psychometric properties of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) Restructured Clinical Scales (RCSs) in individuals with posttraumatic stress disorder (PTSD) receiving clinical services at Department of Veterans Affairs medical centers. Study 1 included 1,098 men who completed the MMPI-2 and were assessed for a range of psychological disorders via structured clinical interview. Study 2 included 136 women who completed the MMPI-2 and were interviewed with the Clinician Administered Scale for PTSD. The utility of the RCSs was compared with that of the Clinical Scales (CSs) and the Keane PTSD (PK) scale. The RCSs demonstrated good psychometric properties and patterns of associations with other measures of psychopathology that corresponded to current theory regarding the structure of comorbidity. A notable advantage of the RCSs compared with the MMPI-2 CSs was their enhanced construct validity and clinical utility in the assessment of comorbid internalizing and externalizing psychopathology. The PK scale demonstrated incremental validity in the prediction of PTSD beyond that of the RCSs or CSs. [ABSTRACT FROM AUTHOR]

This study used structural equation modeling (SEM) to evaluate the relative strength of associations between combat exposure, four posttraumatic stress disorder (PTSD) symptom factors, and functional impairment as indexed by Global Assessment of Functioning (GAF) scores in a sample of 315 veterans assessed at a Department of Veterans Affairs PTSD clinic. Results showed that the association between combat exposure and GAF scores was fully mediated by PTSD severity. The best-fitting model included direct paths from combat exposure to reexperiencing symptoms and from avoidance and numbing symptoms to GAF. However, only 17% of variance in GAF was accounted for by PTSD. The results raise concern about the use of the GAF score as a benchmark for quantifying combat PTSD-related functional impairment. [ABSTRACT FROM AUTHOR]

Mental health disorders are particularly prevalent among public safety personnel (PSP). Emotional Resilience Skills Training (ERST) is a cognitive behavioural training program for PSP based on the Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders (i.e. Unified Protocol). The current study was designed to assess whether ERST is associated with reduced putative risk factors for mental disorders and increased individual resilience. The PSP-PTSI Study used a longitudinal prospective sequential experimental cohort design that engaged each participant for approximately 16 months. PSP from diverse sectors (i.e. firefighters, municipal police, paramedics, public safety communicators) completed self-report measures of several putative risk variables (i.e. anxiety sensitivity, fear of negative evaluation, pain anxiety, illness and injury sensitivity, intolerance of uncertainty, state anger) and resilience at three time points: pre-training ( n  = 191), post-training ( n  = 103), and 1-year follow-up ( n  = 41). Participant scores were statistically compared across time points. Participants reported statistically significantly lower scores on all putative risk variables except pain anxiety, and statistically significantly higher resilience from pre- to post-training. Changes were sustained at 1-year follow-up. The results indicate that ERST is associated with reductions in several putative risk variables and improvement in resilience among PSP.

At the 2023 International Society for Traumatic Stress Studies annual meeting, a panel of three distinguished investigators and clinicians convened to reflect on their careers, their contributions to the field of traumatic stress disorders, and the lessons learned over the years. Dr. Terence M. Keane has guided the development and deployment of evidence-based care, shaping evaluation guidelines and best treatment practices for traumatic stress pathology. Dr. Sheila Rauch, a pioneer in the development of prolonged exposure therapy, has significantly contributed to the treatment of posttraumatic stress disorder (PTSD) and other traumatic stress disorders. Dr. Richard Bryant has developed targeted psychological treatments for traumatic stress and prolonged grief, adapting to the diverse needs, mechanisms, and cultural contexts of patients. These individuals' collective experiences span from the establishment of the PTSD diagnosis to the current proliferation of scientific knowledge on its epidemiology, assessment, and treatment. Their unique yet overlapping contributions have provided invaluable guidelines for the next generation of clinicians and investigators. This panel discussion offers a retrospective look at their careers and a forward-looking perspective on the future of traumatic stress treatment., (© 2024 International Society for Traumatic Stress Studies.)

Objective: In posttraumatic stress disorder (PTSD), the assumption of the equipotentiality of traumas ignores potentially unique contexts and consequences of different traumas. Accordingly, Stein et al. (2012) developed a reliable typing scheme in which assessors categorized descriptions of traumatic events into six "types": life threat to self (LTS), life threat to other, aftermath of violence (AV), traumatic loss, moral injury by self (MIS), and moral injury by other (MIO). We extended this research by validating the typing scheme using participant endorsements of type , rather than assesor-based types. We examined the concordance of participant and assesor types, frequency, and validity of participant-based trauma types by examining associations with baseline mental and behavioral health problems., Method: Interviewers enrolled military personnel and veterans ( N = 1,443) in clinical trials of PTSD and helped them select the most currently distressing Criterion-A trauma. Participants and, archivally, assessors typed the distressing aspect(s) of this experience., Results: AV was the most frequently participant-endorsed type, but LTS was the most frequently rated worst part of an event. Although participants endorsed MIS and MIO the least frequently, these were associated with worse mental and behavioral health problems. The agreement between participants and assessors regarding the worst part of the event was poor., Conclusion: Because of discrepancies between participant and assessor typologies, clinical researchers should use participants' ratings, and these should trump assessor judgment. Differences in pretreatment behavioral and mental health problems across some participant-endorsed trauma types partially support the validity of the participant ratings. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

We used item response theory (IRT) analysis to examine Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) item performance using data from three large samples of veterans (total N = 808) using both binary and ordinal rating methods. Relative to binary ratings, ordinal ratings provided good coverage from well below to well above average within each symptom cluster. However, coverage varied by cluster, and item difficulties were unevenly distributed within each cluster, with numerous instances of redundancy. For both binary and ordinal scores, flashbacks, dissociative amnesia, and self-destructive behavior items showed a pattern of high difficulty but relatively poor discrimination. Results indicate that CAPS-5 ordinal ratings provide good severity coverage and that most items accurately differentiated between participants by severity. Observed uneven distribution and redundancy in item difficulty suggest there is opportunity to create an abbreviated version of the CAPS-5 for determining PTSD symptom severity, but not DSM-5 PTSD diagnosis, without sacrificing precision., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: D.J.L., F.W.W., and M.J.B. receive consultant fees for providing CAPS-5 training to multiple research projects.

The importance of calcium (Ca2+) as a second messenger in T cell signaling is exemplified by genetic deficiencies of STIM1 and ORAI1, which abolish store-operated Ca2+ entry (SOCE) resulting in combined immunodeficiency (CID). We report five unrelated patients with de novo missense variants in ITPR3, encoding a subunit of the inositol 1,4,5-trisphosphate receptor (IP3R), which forms a Ca2+ channel in the endoplasmic reticulum (ER) membrane responsible for the release of ER Ca2+ required to trigger SOCE, and for Ca2+ transfer to other organelles. The patients presented with CID, abnormal T cell Ca2+ homeostasis, incompletely penetrant ectodermal dysplasia, and multisystem disease. Their predominant T cell immunodeficiency is characterized by significant T cell lymphopenia, defects in late stages of thymic T cell development, and impaired function of peripheral T cells, including inadequate NF-κB- and NFAT-mediated, proliferative, and metabolic responses to activation. Pathogenicity is not due to haploinsufficiency, rather ITPR3 protein variants interfere with IP3R channel function leading to depletion of ER Ca2+ stores and blunted SOCE in T cells., (© 2024 Blanco et al.)

Mammalian AIM-2-like receptor (ALR) proteins bind nucleic acids and initiate production of type I interferons or inflammasome assembly, thereby contributing to host innate immunity. In mice, the Alr locus is highly polymorphic at the sequence and copy number level, and we show here that it is one of the most dynamic regions of the genome. One rapidly evolving gene within this region, Ifi207 , was introduced to the Mus genome by gene conversion or an unequal recombination event a few million years ago. Ifi207 has a large, distinctive repeat region that differs in sequence and length among Mus species and even closely related inbred Mus musculus strains. We show that IFI207 controls murine leukemia virus (MLV) infection in vivo and that it plays a role in the STING-mediated response to cGAMP, dsDNA, DMXXA, and MLV. IFI207 binds to STING, and inclusion of its repeat region appears to stabilize STING protein. The Alr locus and Ifi207 provide a clear example of the evolutionary innovation of gene function, possibly as a result of host-pathogen co-evolution.IMPORTANCEThe Red Queen hypothesis predicts that the arms race between pathogens and the host may accelerate evolution of both sides, and therefore causes higher diversity in virulence factors and immune-related proteins, respectively . The Alr gene family in mice has undergone rapid evolution in the last few million years and includes the creation of two novel members, MndaL and Ifi207. Ifi207 , in particular, became highly divergent, with significant genetic changes between highly related inbred mice. IFI207 protein acts in the STING pathway and contributes to anti-retroviral resistance via a novel mechanism. The data show that under the pressure of host-pathogen coevolution in a dynamic locus, gene conversion and recombination between gene family members creates new genes with novel and essential functions that play diverse roles in biological processes., Competing Interests: The authors declare no conflict of interest.

We examined transdiagnostic and posttraumatic stress disorder (PTSD)-specific associations with multiple forms of trauma exposure within a nationwide U.S. sample (N = 1,649, 50.0% female) of military veterans overselected for PTSD. A higher-order Distress factor was estimated using PTSD, major depressive disorder (MDD), and generalized anxiety disorder (GAD) symptoms as indicators. A structural equation model spanning three assessment points over an average of 3.85 years was constructed to examine the unique roles of higher-order Distress and PTSD-specific variance in accounting for the associations between trauma exposure, measured using the Life Events Checklist (LEC) and Deployment Risk and Resiliency Inventory Combat subscale (DRRI-C), and psychosocial impairment. The results suggest the association between trauma exposure and PTSD symptoms was primarily mediated by higher-order distress (70.7% of LEC effect, 63.2% of DRRI-C effect), but PTSD severity retained a significant association with trauma exposure independent of distress, LEC: β = .10, 95% CI [.06, .13]; DRRI-C: β = .11, 95% CI [.07, .14]. Both higher-order distress, β = .31, and PTSD-specific variance, β = .36, were necessary to account for the association between trauma exposure and future impairment. Findings suggest that trauma exposure may contribute to comorbidity across a range of internalizing symptoms as well as to PTSD-specific presentations., (© 2024 International Society for Traumatic Stress Studies.)

Cognitive behavioral conjoint therapy for posttraumatic stress disorder (CBCT for PTSD; Monson & Fredman, 2012) is associated with improvements in patients' and partners' mental health and relationship satisfaction. Some pretreatment relationship characteristics have predicted CBCT for PTSD outcomes for patients, but findings were limited to a single community sample consisting primarily of female patients with male partners. A better understanding of whether pretreatment relationship characteristics predict outcomes in other patient populations and whether there are partners who may be particularly responsive to couple therapy for PTSD could optimize treatment matching. This study investigated whether pretreatment partner accommodation and relationship satisfaction predicted patient and partner treatment outcomes from an uncontrolled trial of an abbreviated, intensive, multicouple group version of CBCT for PTSD conducted with 24 active-duty military or veteran couples (96% male patients/female partners). In general, changes in patients' PTSD and comorbid symptoms and relationship satisfaction did not vary by pretreatment partner accommodation or patients' own pretreatment relationship satisfaction. In contrast, pretreatment relationship characteristics predicted partner outcomes. Partners who engaged in higher levels of accommodation pretreatment and partners who reported lower levels of pretreatment relationship satisfaction experienced greater declines in psychological distress following treatment. Also, partners who began the study relationally distressed exhibited significant increases in relationship satisfaction following treatment, whereas those who were not relationally distressed did not. Findings suggest that improvements generally do not vary by pretreatment relationship characteristics for patients, whereas partners who begin treatment with elevated relationship risk factors may be especially likely to experience improvement across outcomes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Background: With few exceptions, previously conducted research on hazardous drinking among Veterans has employed samples in which the majority of participants identify as male. In addition, past studies have solely focused on alcohol consumption, rather than associated risk for dependence. In this study, we expanded upon the extant literature by investigating sex differences in trajectories and predictors of change in alcohol consumption and dependence risk among post-9/11 Veterans., Methods: A national sample of 1649 Veterans (50.0% female) were recruited in a five-wave longitudinal study that followed Veterans for up to 16 years after deployment. We used growth curve modeling to investigate trajectories of change in alcohol consumption and dependence risk among men and women Veterans. We examined predictors of growth, including demographics, support and resources, psychiatric symptoms, and trauma exposure., Results: Among male Veterans, alcohol consumption and dependence risk remained stagnant, which is in contrast to past work using non-Veteran samples. For female Veterans, consumption exhibited initial reductions that decelerated, and dependence risk reduced at a continuous rate. PTSD diagnosis was a significant predictor of individual differences in growth for men. Psychiatric symptoms (i.e., PTSD diagnosis, probable depression diagnosis, suicidal ideation) and psychosocial functioning were significant predictors of decreasing alcohol use for women., Conclusions: Results highlight important sex differences in patterns and predictors of change in alcohol consumption and dependence risk among post-9/11 Veterans. Findings are discussed in relation to screening for hazardous alcohol use and intervention strategies in this at-risk population., Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest., (Copyright © 2024. Published by Elsevier B.V.)

Summary: Semantic ontology mapping of clinical descriptors with disease outcome is essential. ClinVar is a key resource for human variation with known clinical significance. We present CMAT, a software toolkit and curation protocol for accurately enriching ClinVar releases with disease ontology associations and complex functional consequences., Availability and Implementation: The software and ontology mappings can be obtained from: https://github.com/EBIvariation/CMAT., Competing Interests: None declared., (© The Author(s) 2024. Published by Oxford University Press.)

Subthreshold posttraumatic stress disorder (PTSD) has long been recognized as an important construct that identifies a subgroup of individuals who report significant PTSD symptoms and associated disability but do not endorse enough symptoms to meet the criteria for a full PTSD diagnosis. Different investigators have defined subthreshold PTSD in various ways, making it difficult to interpret findings across studies. To address this problem, we systematically compared individuals who met criteria for nine different subthreshold PTSD definitions with individuals diagnosed with either full PTSD or no PTSD (i.e., failed to meet the criteria for a subthreshold definition) with respect to prevalence and associated clinical outcomes of interest. Participants were 1,082 veterans enrolled in the Veterans After Discharge Longitudinal Registry. PTSD and subthreshold PTSD diagnostic status were determined using the Structured Clinical Interview for DSM-5 (SCID-5) and validated self-report instruments were used to assess clinical outcomes. Across outcomes, subthreshold definitions generally identified a group of participants that was distinguishable from participants in both the PTSD and no PTSD groups, rs = .02-.47. We discuss the benefits and drawbacks of various subthreshold definitions and highlight the need for additional work evaluating these definitions across additional outcomes and samples. In the interim, we propose a working case definition of subthreshold PTSD as meeting any three of the four DSM-5 symptom criteria (i.e., Criteria B, C, D, and E) along with Criterion A and Criteria F-H. The results suggest subthreshold PTSD is a clinically meaningful construct., (Published 2023. This article is a U.S. Government work and is in the public domain in the USA.)

Prior studies on individuals with posttraumatic stress disorder (PTSD) defined an adequate dose of psychotherapy as receiving at least nine sessions within a 15-week period. Yet, few studies have examined whether this definition of adequate dose is associated with meaningful change in PTSD symptoms over an extended period. To examine whether an adequate dose of individual or group psychotherapy was associated with PTSD symptom improvement, we identified mental health outpatient visits in the electronic medical record for a cohort of veterans enrolled in Veterans Health Administration (VHA) services ( N = 1,649) across 5 years. Using latent growth curve modeling, we estimated the effect of receiving an adequate dose of psychotherapy on the PTSD symptom course. Among the sample, 992 participants (60.16%) received at least one individual therapy session and 506 participants (30.7%) received at least one group therapy session; of those, 226 (22.78%) received an adequate dose of individual therapy and 212 (41.9%) received an adequate dose of group therapy, respectively. An adequate individual therapy dose, but not group therapy dose, was associated with a decrease in PTSD Checklist for DSM-5 (PCL-5) scores over time. This improvement was extremely gradual (average of 1.57 PCL-5 point decrease per year). Adequate dose of psychotherapy, defined as nine sessions of routine psychotherapy over 15 weeks, is associated with minimal symptom change. This suggests that commonly used definitions of adequate dose have minimal clinical utility. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Background: Posttraumatic stress disorder (PTSD) is a debilitating psychological disorder that is associated with a host of psychosocial and health ailments, including chronic pain. Although evidence-based psychological therapies are recommended as first-line PTSD treatments, a large proportion of individuals either drop out and/or do not achieve a therapeutic response. PTSD is increasingly recognized as a systemic disorder that impacts both physical and mental health, and mind-body approaches, such as Tai Chi, have shown promise. However, to date there have been no randomized clinical trials examining Tai Chi as a treatment for PTSD. Objective: To conduct a fully remote two-phased study designed to adapt, refine, and standardize two group treatments, Tai Chi and a Wellness comparison, for Veterans diagnosed with PTSD and chronic pain. Method: We deploy the project in two phases. In Phase One , we adapt both interventions for delivery via a videoconferencing platform. We then pilot the interventions in a 'dry run' with non-random assignment of 12 participants to Tai Chi or a Wellness comparison group. In Phase Two , we randomize 36 participants to one of the two group interventions. The feasibility and acceptability of the two remotely delivered interventions and assessment protocols are evaluated. Conclusions: This is the first study to our knowledge to evaluate the feasibility, acceptability, adherence, and participant burden of the Tai Chi and Wellness comparison interventions for PTSD and chronic pain in Veterans. This information will facilitate the development of a future large, randomized control trial to evaluate the efficacy of Tai Chi to address PTSD and chronic pain in Veterans.

Background: Symptom accommodation by family members (FMs) of individuals with posttraumatic stress disorder (PTSD) includes FMs' participation in patients' avoidance/safety behaviours and constraining self-expression to minimise conflict, potentially maintaining patients' symptoms. The Significant Others' Responses to Trauma Scale (SORTS) is the only existing measure of accommodation in PTSD but has not been rigorously psychometrically tested. Objective: We aimed to conduct further psychometric analyses to determine the factor structure and overall performance of the SORTS. Method: We conducted exploratory and confirmatory factor analyses using a sample of N  = 715 FMs (85.7% female, 62.1% White, 86.7% romantic partners of individuals with elevated PTSD symptoms). Results: After dropping cross-loading items, results indicated good fit for a higher-order model of accommodation with two factors: an anger-related accommodation factor encompassed items related largely to minimising conflict, and an anxiety-related accommodation factor encompassed items related primarily to changes to the FM's activities. Accommodation was positively related to PTSD severity and negatively related to relationship satisfaction, although the factors showed somewhat distinct associations. Item Response Theory analyses indicated that the scale provided good information and robust coverage of different accommodation levels. Conclusions: SORTS data should be analysed as both a single score as well as two factors to explore the factors' potential differential performance across treatment and relationship outcomes.

Objective: Alcohol-related problems (e.g., physical, interpersonal, intrapersonal, impulse control, social responsibility) can have an impact on posttraumatic stress disorder (PTSD) symptoms during treatment. Evidence-based online self-help tools exist to target alcohol use and related problems and co-occurring PTSD symptoms. It is unknown to what degree individuals with varying alcohol-related problems respond differently to web-based interventions for hazardous alcohol use and PTSD. The current study evaluated specific alcohol-related problems as potential moderators of PTSD symptom changes during the VetChange online intervention while controlling for average daily alcohol use, gender, race, and age., Method: We conducted a secondary analysis of a randomized controlled trial that included 600 post-9/11 veterans (518 men and 82 women). Mixed-effects regression models of alcohol-related problems on PTSD severity scores over time were performed separately in an initial intervention group (IIG; n = 404) and a delayed intervention group (DIG; n = 196) that was used as a comparison condition., Results: Interpersonal problems emerged as a moderator of PTSD symptom changes in IIG such that veterans endorsing greater interpersonal problems demonstrated larger reductions in PTSD symptoms throughout VetChange. There were no significant moderation effects in DIG. Non-White veterans reported significantly higher PTSD symptoms during VetChange. Post hoc analyses indicated that veterans with higher interpersonal problems were more likely to engage in online intervention content focused on identifying high-risk drinking situations and coping with symptoms., Conclusions: Findings imply that veterans reporting alcohol-related interpersonal problems may benefit the most from, and be more motivated to use, online interventions for hazardous alcohol use and PTSD symptoms.

Objective: Rates of hazardous alcohol consumption and co-occurring posttraumatic stress disorder (PTSD) are high among returning combat veterans and may adversely affect satisfaction with life (SWL). Improving life satisfaction represents a potential secondary outcome of web-based interventions for alcohol use and PTSD. Understanding the relationship between intervention targets and SWL may help inform future interventions and provide clarity regarding how improvements are manifesting. We examined returning veterans enrolled in VetChange, an evidence-based web intervention for co-occurring alcohol use and PTSD, to determine changes in SWL over time and as a function of changes in alcohol consumption and PTSD symptoms., Method: Participants included 222 returning veterans who reported hazardous drinking. Veterans engaged in a nationwide implementation of VetChange and completed measures of average weekly drinks (AWD), PTSD symptoms, and SWL at baseline, 1, 3, and 6 months. We investigated the effects of changes in PTSD and AWD between baseline and 1 month on SWL over 6 months using linear mixed-effects modeling., Results: Across all veterans, SWL increased by 19% over 6 months. AWD and PTSD decreased between baseline and 1 month, but only change in PTSD predicted changes in SWL over the 6-month interval., Conclusions: Reductions in PTSD symptoms within the first month of intervention use, and not reductions in drinking, predicted increased SWL over 6 months. SWL is an important marker for recovery and related quality of life, and an important assessment and intervention target of web-based interventions. Interventions may also target SWL, as improvements in SWL promote future recovery and sustained improvement. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Posttraumatic stress disorder (PTSD) changed substantially when Diagnostic and Statistical Manual of Mental Disorders transitioned from fourth ( DSM-IV ) to fifth ( DSM-5 ) edition. Hoge et al. found that although diagnostic prevalence remained consistent across nomenclatures, diagnostic concordance was low (55%). Study goals were to examine both the generalizability of these findings and whether either diagnosis systematically excluded patients. U.S. veterans ( N = 1,171) who completed the PTSD Checklist for DSM-IV (PCL-S) and DSM-5 (PCL-5) were classified as: probable PTSD on both measures; probable PTSD on PCL-S only; probable PTSD on PCL-5 only; or no PTSD on either measure. Diagnostic prevalence was equivalent. Unlike Hoge et al.'s findings, diagnostic concordance was high (91.3%). Furthermore, observed demographic and severity differences were driven by disparities between veterans in the no PTSD versus the probable PTSD groups, not diagnostic changes. Findings suggest translatability across measures and that diagnostic changes do not systematically exclude patients.

We assessed the interrater reliability, convergent validity, and discriminant validity of the Self-Injurious Thoughts and Behaviors Interview-Short Form (SITBI-SF) in a sample of 1,944 active duty service members and veterans seeking services for posttraumatic stress disorder (PTSD) and related conditions. The SITBI-SF demonstrated high interrater reliability and good convergent and discriminant validity. The measurement properties of the SITBI-SF were comparable across service members and veterans. Approximately 8% of participants who denied a history of suicidal ideation on the SITBI-SF reported suicidal ideation on a separate self-report questionnaire (i.e., discordant responders). Discordant responders reported significantly higher levels of PTSD symptoms than those who denied suicidal ideation on both response formats. Findings suggest that the SITBI-SF is a reliable and valid interview-based measure of suicide-related thoughts and behaviors for use with military service members and veterans. Suicide risk assessment might be optimized if the SITBI-SF interview is combined with a self-report measure of related constructs.

Objective: Royal Canadian Mounted Police (RCMP) report extremely frequent and varied exposures to potentially psychologically traumatic events (PPTEs). While occupational exposures to PPTEs may be one explanation for the symptoms of mental disorders prevalent among serving RCMP, exposures occurring prior to service may also play a role. The objective of the current study was to provide estimates of lifetime PPTE exposures among RCMP cadets in training and assess for associations with mental disorders or sociodemographic variables., Methods: RCMP cadets ( n   =  772; 72.0% male) beginning the Cadet Training Program (CTP) completed a survey assessing self-reported PPTE exposures as measured by the Life Events Checklist for the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition-Extended. Binomial tests were conducted to compare the current results to previously collected data from the general population, a diverse sample of public safety personnel (PSP) and serving RCMP., Results: Cadets reported statistically significantly fewer PPTE exposures for all PPTE types than serving RCMP (all p' s < 0.001) and PSP (all p' s < 0.001) but more PPTE exposures for all PPTE types than the general population (all p' s < 0.001). Cadets also endorsed fewer PPTE types (6.00  ±  4.47) than serving RCMP (11.64  ±  3.40; p  < 0.001) and other PSP (11.08  ±  3.23) but more types than the general population (2.31  ±  2.33; p  < 0.001). Participants who reported being exposed to any PPTE type reported the exposures occurred 1-5 times (29.1% of participants), 6-10 times (18.3%) or 10  +  times (43.1%) before starting the CTP. Several PPTE types were associated with positive screens for one or more mental disorders. There were associations between PPTE types and increased odds of screening positive for post-traumatic stress disorder (PTSD), major depressive disorder (MDD), generalized anxiety disorder (GAD) and social anxiety disorder (SAD) (all p's  < 0.05). Serious transport accident (11.1%), physical assault (9.5%) and sudden accidental death (8.4%) were the PPTEs most identified as the worst event, and all were associated with positive screens for one or more mental disorders., Conclusion: The current results provide the first information describing PPTE histories of cadets, evidencing exposure frequencies and types much higher than the general population. PPTE exposures may have contributed to the cadet's vocational choices. The current results support the growing evidence that PPTEs can be associated with diverse mental disorders; however, the results also suggest cadets may be uncommonly resilient, based on how few screened positive for mental disorders, despite reporting higher frequencies of PPTE exposures prior to CTP than the general population.

Objective: Serving Royal Canadian Mounted Police (RCMP) have screened positive for one or more mental disorders based on self-reported symptoms with substantial prevalence (i.e., 50.2%). Mental health challenges for military and paramilitary populations have historically been attributed to insufficient recruit screening; however, cadet mental health when starting the Cadet Training Program (CTP) was unknown. Our objective was to estimate RCMP Cadet mental health when starting the CTP and test for sociodemographic differences., Method: Cadets starting the CTP completed a survey assessing self-reported mental health symptoms ( n  = 772, 72.0% male) and a clinical interview ( n  = 736, 74.4% male) with a clinician or supervised trainee using the Mini-International Neuropsychiatric Interview to assess current and past mental health., Results: The percentage of participants screening positive for one or more current mental disorders based on self-reported symptoms (15.0%) was higher than the diagnostic prevalence for the general population (10.1%); however, based on clinical interviews, participants were less likely to screen positive for any current mental disorder (6.3%) than the general population. Participants were also less likely to screen positive for any past mental disorder based on self-report (3.9%) and clinical interviews (12.5%) than the general population (33.1%). Females were more likely to score higher than males (all p s<.01; Cohen's d s .23 to .32) on several self-report mental disorder symptom measures., Conclusions: The current results are the first to describe RCMP cadet mental health when starting the CTP. The data evidenced a lower prevalence of anxiety, depressive, and trauma-related mental disorders than the general population based on clinical interviews, contrasting notions that more rigorous mental health screening would reduce the high prevalence of mental disorders among serving RCMP. Instead, protecting RCMP mental health may require ongoing efforts to mitigate operational and organizational stressors.

Insomnia and nightmares are common in patients with posttraumatic stress disorder (PTSD). They are associated with worse psychological and physical health and worse PTSD treatment outcomes. In addition, they are resistant to PTSD treatments, which do not typically address sleep disorders. Cognitive behavioral therapy for insomnia and nightmares (CBT-I&N) and cognitive processing therapy (CPT) for PTSD are first-line treatments, but limited evidence exists guiding the treatment of individuals with all three disorders. The current study randomized U.S. military personnel (N = 93) to one of three conditions: CBT-I&N delivered before CPT, CBT-I&N delivered after CPT, or CPT alone; all groups received 18 sessions. Across groups, participants demonstrated significantly improved PTSD symptoms. Because the study was terminated prematurely due to challenges with recruitment and retention, it was underpowered to answer the initially intended research questions. Nonetheless, statistical findings and relevant clinically meaningful changes were observed. Compared to participants who received CPT alone, those who received CBT-I&N and CPT, regardless of sequencing, demonstrated larger improvements in PTSD symptoms, d = -0.36; insomnia, d = -0.77; sleep efficiency, d = 0.62; and nightmares, d = -.53. Compared to participants who received CBT-I&N delivered before CPT, those who received CBT-I&N delivered after CPT demonstrated larger improvements in PTSD symptoms, d = 0.48, and sleep efficiency, d = -0.44. This pilot study suggests that treating comorbid insomnia, nightmares, and PTSD symptoms results in clinically meaningful advantages in improvement for all three concerns compared to treating PTSD alone., (© 2023 International Society for Traumatic Stress Studies.)

Better understanding of reasons for and against change may be an effective strategy for supporting drinking reduction or abstinence among Iraq and Afghanistan veterans. The current study explored connections between reasons for and against changing hazardous alcohol use, as well as the relative importance of a given reason. Data from 366 veterans (86% male, 77% White) between the ages of 21 and 56 (M = 31.8, SD = 7.3) were obtained from a nationwide web-based alcohol and posttraumatic stress disorder randomized clinical trial. Participant-generated reasons for and against change were used to estimate two separate network models. The network of motives for changing alcohol use was generally well connected with predominately positive associations. Veterans reporting motivation to change alcohol use to improve functioning, enhance self-worth, and decrease alcohol-related consequences tended to have higher than average motivation to reduce or abstain from alcohol use. Alternatively, the network structure of motives against changing alcohol use demonstrated a nearly equal number of positive and negative associations. Whereas reasons to cope and sleep may imply higher than average motivation to continue drinking the same, veterans reporting reasons to reduce anxiety and have fun tended to have lower than average motivation to continue drinking. The current study may inform content modifications to self-help tools to more quickly and effectively target users' motivations from the beginning. Capitalizing on intervention users' motivations early may promote sustained engagement or improve therapeutic impact among those who only use the intervention for a short period of time., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Published by Elsevier Ltd.)

Background: Network modeling has been applied in a range of trauma-exposed samples, yet results are limited by an over reliance on cross-sectional data. The current analyses used posttraumatic stress disorder (PTSD) symptom data collected over a 5-year period to estimate a more robust between-subject network and an associated symptom change network., Methods: A PTSD symptom network is measured in a sample of military veterans across four time points ( N s = 1254, 1231, 1106, 925). The repeated measures permit isolating between-subject associations by limiting the effects of within-subject variability. The result is a highly reliable PTSD symptom network. A symptom slope network depicting covariation of symptom change over time is also estimated., Results: Negative trauma-related emotions had particularly strong associations with the network. Trauma-related amnesia, sleep disturbance, and self-destructive behavior had weaker overall associations with other PTSD symptoms., Conclusions: PTSD's network structure appears stable over time. There is no single 'most important' node or node cluster. The relevance of self-destructive behavior, sleep disturbance, and trauma-related amnesia to the PTSD construct may deserve additional consideration.

Associations between human genetic variation and clinical phenotypes have become a foundation of biomedical research. Most repositories of these data seek to be disease-agnostic and therefore lack disease-focused views. The Type 2 Diabetes Knowledge Portal (T2DKP) is a public resource of genetic datasets and genomic annotations dedicated to type 2 diabetes (T2D) and related traits. Here, we seek to make the T2DKP more accessible to prospective users and more useful to existing users. First, we evaluate the T2DKP's comprehensiveness by comparing its datasets with those of other repositories. Second, we describe how researchers unfamiliar with human genetic data can begin using and correctly interpreting them via the T2DKP. Third, we describe how existing users can extend their current workflows to use the full suite of tools offered by the T2DKP. We finally discuss the lessons offered by the T2DKP toward the goal of democratizing access to complex disease genetic results., Competing Interests: Declaration of interests A.C. is a Sanofi employee and holds shares and stock options in the company. M.I.M. has served on advisory panels for Pfizer, Novo Nordisk, and Zoe Global; has received honoraria from Merck, Pfizer, Novo Nordisk, and Eli Lilly; and received research funding from Abbvie, Astra Zeneca, Boehringer Ingelheim, Eli Lilly, Janssen, Merck, Novo Nordisk, Pfizer, Roche, Sanofi Aventis, Servier, and Takeda. As of June 2019, M.I.M. is an employee of Genentech and a holder of Roche stock. M.R.M. is a Pfizer employee and holds shares of stock in the company. M.K.T. is an employee and shareholder of Eli Lilly and Company. As of April 2022, P.D. is an employee and stockholder of Regeneron Pharmaceuticals., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Objective: The aim of this study was to determine the efficacy of doxazosin, an α 1 -adrenergic antagonist, for the treatment of co-occurring posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD)., Methods: This 12-week, double-blind, randomized controlled trial of doxazosin (16 mg/d) was conducted between June 2016 and December 2019 at the Ralph H. Johnson VA Medical Center in Charleston, South Carolina. Participants were military veterans (N = 141) who met DSM-5 criteria for current PTSD and AUD and were randomly assigned to receive doxazosin (n = 70) or placebo (n = 71). Primary outcome measures were the Clinician Administered PTSD Scale (CAPS-5), the PTSD Checklist for DSM-5 (PCL-5), and the Timeline Follow-Back (TLFB)., Results: Findings from the intent-to-treat analyses revealed that participants in both groups demonstrated statistically significant reductions in CAPS-5 and PCL-5 scores ( P  < .0001), but, contrary to hypotheses, no significant differences were observed between groups. Percent drinking days and percent heavy drinking days also decreased significantly during treatment, but there were no differences between groups ( P  < .0001). Abstinence during treatment was significantly higher in the doxazosin versus the placebo group (22% vs 7%, P  = .017); however, participants in the doxazosin group consumed a greater number of drinks on drinking days (6.15 vs 4.56, P  = .0096). A total of 74.5% of the sample completed the treatment phase, and there were no group differences in retention or adverse events., Conclusions: Doxazosin was safe and tolerable but was not more effective than placebo in reducing PTSD or AUD severity in this dually diagnosed sample. Clinical considerations such as heterogeneity of PTSD and AUD presentation and potential moderators are discussed in the context of future research directions., Trial Registration: ClinicalTrials.gov Identifier: NCT02500602., (© Copyright 2023 Physicians Postgraduate Press, Inc.)

Objective: To explore whether the association between change in headache management self-efficacy and posttraumatic headache-related disability is partially mediated by a change in anxiety symptom severity., Background: Many cognitive-behavioral therapy treatments for headache emphasize stress management, which includes anxiety management strategies; however, little is currently known about mechanisms of change in posttraumatic headache-related disability. Increasing our understanding of mechanisms could lead to improvements in treatments for these debilitating headaches., Methods: This study is a secondary analysis of veterans (N = 193) recruited to participate in a randomized clinical trial of cognitive-behavioral therapy, cognitive processing therapy, or treatment as usual for persistent posttraumatic headache. The direct relationship between headache management self-efficacy and headache-related disability, along with partial mediation through change in anxiety symptoms was tested., Results: The mediated latent change direct, mediated, and total pathways were statistically significant. The path analysis supported a significant direct pathway between headache management self-efficacy and headache-related disability (b = -0.45, p < 0.001; 95% confidence interval [CI: -0.58, -0.33]). The total effect of change of headache management self-efficacy scores on change in Headache Impact Test-6 scores was significant with a moderate-to-strong effect (b = -0.57, p = 0.001; 95% CI [-0.73, -0.41]). There was also an indirect effect through anxiety symptom severity change (b = -0.12, p = 0.003; 95% CI [-0.20, -0.04])., Conclusions: In this study, most of the improvements in headache-related disability were related to increased headache management self-efficacy with mediation occurring through change in anxiety. This indicates that headache management self-efficacy is a likely mechanism of change of posttraumatic headache-related disability with decreases in anxiety explaining part of the improvement in headache-related disability., (© 2023 American Headache Society.)

Importance: Improved, efficient, and acceptable treatments are needed for combat-related posttraumatic stress disorder (PTSD)., Objective: To determine the efficacy of 2 compressed prolonged exposure (PE) therapy outpatient treatments for combat-related PTSD., Design, Setting, and Participants: This randomized clinical trial was conducted among military personnel and veterans at 4 sites in Texas from 2017 to 2019. Assessors were blinded to conditions. Data were analyzed from November 2020 to October 2022., Interventions: The interventions were massed-PE, which included 15 therapy sessions of 90 minutes each over 3 weeks, vs intensive outpatient program PE (IOP-PE), which included 15 full-day therapy sessions over 3 weeks with 8 treatment augmentations. The IOP-PE intervention was hypothesized to be superior to massed-PE., Main Outcomes and Measures: Coprimary outcomes included the Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) (CAPS-5) and the PTSD Checklist for DSM-5 (PCL-5) administered at baseline and posttreatment follow-ups. Measures ranged from 0 to 80, with higher scores indicating greater severity. Diagnostic remission and reliable change were secondary outcomes., Results: Among 319 military personnel and veterans screened, 234 were randomized (mean [SD] age, 39.20 [7.72] years; 182 [78%] male participants), with 117 participants randomized to IOP-PE and 117 participants randomized to massed-PE. A total of 61 participants (26%) were African American, 58 participants (25%) were Hispanic, and 102 participants (44%) were White; 151 participants (65%) were married. Linear mixed-effects models found that CAPS-5 scores decreased in both treatment groups at the 1-month follow-up (IOP-PE: mean difference, -13.85 [95% CI, -16.47 to -11.23]; P < .001; massed-PE: mean difference, -14.13 [95% CI, -16.63 to -11.62]; P < .001). CAPS-5 change scores differed from 1- to 6-month follow-ups (mean difference, 4.44 [95% CI, 0.89 to 8.01]; P = .02). PTSD symptoms increased in massed-PE participants during follow-up (mean difference, 3.21 [95% CI, 0.65 to 5.77]; P = .01), whereas IOP-PE participants maintained treatment gains (mean difference, 1.23 [95% CI, -3.72 to 1.27]; P = .33). PCL-5 scores decreased in both groups from baseline to 1-month follow-up (IOP-PE: mean difference, -21.81 [95% CI, -25.57 to -18.04]; P < .001; massed-PE: mean difference, -19.96 [95% CI, -23.56 to -16.35]; P < .001) and were maintained at 6 months (IOP-PE: mean change, -0.21 [95% CI, -3.47 to 3.06]; P = .90; massed-PE: mean change, 3.02 [95% CI, -0.36 to 6.40]; P = .08). Both groups had notable PTSD diagnostic remission at posttreatment (IOP-PE: 48% [95% CI, 36% to 61%] of participants; massed-PE: 62% [95% CI, 51% to 73%] of participants), which was maintained at 6 months (IOP-PE: 53% [95% CI, 40% to 66%] of participants; massed-PE: 52% [95% CI, 38% to 66%] of participants). Most participants demonstrated reliable change on the CAPS-5 (61% [95% CI, 52% to 69%] of participants) and the PCL-5 (74% [95% CI, 66% to 81%] of participants) at the 1-month follow-up., Conclusions and Relevance: These findings suggest that PE can be adapted into compressed treatment formats that effectively reduce PTSD symptoms., Trial Registration: ClinicalTrials.gov Identifier: NCT03529435.

Researchers studying posttraumatic stress disorder (PTSD) often use diagnostic codes within electronic medical records (EMRs) to identify individuals with the disorder. This study evaluated the performance of algorithms for defining PTSD based on International Classification of Diseases (ICD) code use within EMR data. We used data from a registry of U.S. veterans for whom both structured interview data and Veterans Health Administration EMR data were available. Using interview-diagnosed PTSD as the reference criterion, we calculated diagnostic accuracy statistics for algorithms that required the presence of at least one and up to seven encounters in which a PTSD diagnosis was present in EMR data within any clinical source, mental health clinic, or specialty PTSD clinic. We evaluated algorithm accuracy in the total sample (N = 1,343; 64.1% with PTSD), within a subsample constrained to lower PTSD prevalence (n = 712; 32.3% with PTSD), and as a function of demographic characteristics. Algorithm accuracy was influenced by PTSD prevalence. Results indicated that higher thresholds for the operationalization of PTSD may be justified among samples in which PTSD prevalence is lower. Requiring three PTSD diagnoses from a mental health clinic or four diagnoses from any clinical source may be a suitable minimum standard for identifying individuals with PTSD in EMRs; however, accuracy may be optimized by requiring additional diagnoses. The performance of many algorithms differed as a function of educational attainment and age, suggesting that samples of individuals with PTSD developed based on EMR ICD codes may skew toward including older, less-educated veterans., (Published 2022. This article is a U.S. Government work and is in the public domain in the USA.)

Prior research suggests that anhedonia symptoms related to posttraumatic stress disorder (PTSD; i.e., diminished interest, detachment from others, and difficulty experiencing positive emotions) are consistently associated with a higher degree of impairment in psychosocial functioning beyond that associated with other PTSD symptoms. Unfortunately, much of this research has used cross-sectional study designs; relied upon outdated DSM diagnostic criteria; and failed to control for potentially confounding variables, such as the presence of co-occurring depression. This study used data from Waves 2 and 4 (n = 1,649) of the Veterans' After-Discharge Longitudinal Registry (Project VALOR), a longitudinal dataset of U.S. Army and Marine veterans. As measured using the Inventory of Psychosocial Functioning, Wave 4 psychosocial functioning was regressed on seven PTSD symptom factors at Wave 2 (i.e., intrusions, avoidance, negative affect, anhedonia, externalizing behaviors, anxious arousal, and dysphoric arousal) and potential Wave 2 confounds. The Anhedonia factor, β = .123, most strongly predicted later psychosocial functional impairment beyond the impact of other PTSD symptom factors, βs = -.076-.046. Clinical implications of these findings are also discussed., (© 2022 The Authors. Journal of Traumatic Stress published by Wiley Periodicals LLC on behalf of International Society for Traumatic Stress Studies.)

Prior research indicates that veterans are interested in including family members in health care and that family-inclusive mental health treatment can improve treatment outcomes. Consequently, the Veterans Health Administration's (VHA) directive requires providers to offer family-inclusive mental health services to veterans. However, the extent to which veterans engage in family-inclusive mental health services at the VHA remains unclear. Using data from a longitudinal registry of male and female veterans with and without posttraumatic stress disorder, we examined the extent to which veterans included family members in their mental health care and predictors of engagement in family-involved therapy visits using VHA administrative records over a 5-year time span. Of the 1,329 veterans who received mental health care during the study, 8.4% received a family therapy visit-the number of visits per veteran ranged from 1 to 34. Results from logistic regressions indicate that relative to White veterans, Black veterans were 61.0% less likely to receive a family-involved therapy visit. Married veterans or veterans living with a partner, and veterans with poor romantic relationship functioning, were more likely to receive a family-involved therapy visit. These findings indicate that only a small percentage of veterans received a family therapy visit across 5 years. Efforts to understand barriers to family-involved therapy visits and strategies to increase engagement in family-involved visits may improve clinical outcomes and promote patient-centered care., (Copyright © 2022. Published by Elsevier Ltd.)

This study examined whether romantic relationship functioning was associated with mental health treatment utilization in male and female veterans. Veterans ( N = 760) enrolled in a longitudinal registry completed self-report measures and a diagnostic interview for posttraumatic stress disorder (PTSD). Mental health treatment utilization data procured from Veterans Affairs administrative records were analyzed over 12 months. For men with PTSD, greater romantic relationship dysfunction was associated with more total mental health visits, medication management visits, and group psychotherapy visits. For women with PTSD, romantic relationship dysfunction was negatively associated with total mental health, individual psychotherapy, and group therapy visits. For women without PTSD, greater relationship dysfunction was associated with fewer total mental health visits and group therapy visits. For men, relationship difficulties appear to be positively related to mental health service use; however, for women, relationship difficulties appear to have no relation or a negative relation to mental health service use. (PsycInfo Database Record (c) 2022 APA, all rights reserved).