Combat guilt and its relationship to PTSD symptoms

Guilt regarding combat experiences is often considered an associated symptom of PTSD in military veterans. Little is known, however, about the role combat guilt plays in the development and maintenance of PTSD. Inadequate measurement of combat-related guilt may be one reason for this deficiency in the literature. In the present study, 40 veterans with PTSD completed a novel measure of combat guilt. Items on the scale assessed various types of guilt and shame concerning combat experiences (i.e., survival guilt, guilt over acts of omission and acts of commission, guilt about thoughts/feelings). Guilt was quite prevalent within this sample, and severity of guilt regarding combat was positively correlated with the reexperiencing and avoidance symptoms of PTSD and a general measure of PTSD severity. Implications of these findings and recommendations for the development of measures for combat-related guilt are discussed. © 1997 John Wiley & Sons, Inc. J Clin Psychol 53: 801–808, 1997     

The role of ethnic identity in the relationship of race-related stress to PTSD symptoms among young adults.

Although many studies have shown that stronger ethnic identity is associated with better adjustment, the role of ethnic identity in the context of race-related threat is unclear. The purpose of this study was to examine the effect of ethnic identity on the severity of posttraumatic stress disorder (PTSD) symptoms in the context of race-related stress, particularly to examine whether ethnic identity moderates the effect of racism on consequent PTSD symptoms. Subjects were 91 undergraduate students (11% Caucasian, 6.6% African American, 18.7% Hispanic, 47.3% Asian, 5.5% Middle Eastern, and 8.8% Other) who reported experiences of race-related stress. Race-related stress, ethnic identity, and PTSD symptoms were assessed through self-report measures. Results of a simultaneous multiple regression indicated that ethnic identity moderated PTSD symptoms in response to perceived racism, such that stronger ethnic identity was associated with more PTSD symptoms in the face of increasing levels of race-related stress. Additionally, race-related stress independently predicted PTSD symptoms. These results are consistent with previous findings that ethnic identity increases the experience of distress in the context of self-relevant threat.     

Perceived barriers to opportunity and their relation to substance use among Latino immigrant men

Theory and empirical evidence suggest that perceived barriers to opportunity, such as discrimination, can lead to the adoption of unhealthy behaviors. The study assessed the relationship between perceived racial/ethnic, language and legal status barriers to opportunity and substance use among Latino immigrant men in North Carolina. Logistic regression was used to test for the association between perceived barriers and odds of binge drinking in the past 30 days and cigarette smoking. In both crude and adjusted models, perceived language barriers (OR = 3.05, 95% CI: 1.78–5.25) and legal status barriers (OR = 2.25, 95% CI: 1.26–4.01) were associated with increased odds of having engaged in binge drinking. Perceived barriers to opportunity were not significantly associated with cigarette smoking. Further research is needed to better understand the effect of language and legal status barriers on health among Latino immigrants.     

PTSD treatment and 5-year remission among patients with substance use and posttraumatic stress disorders

Given the high prevalence of comorbid substance use and posttraumatic stress disorders (SUD-PTSD), how to best treat these patients is a pressing concern for SUD providers. PTSD treatment may play an important role in patients' recovery. One hundred male SUD-PTSD patients who attended SUD treatment completed 1-. 2-, and 5-year follow-ups. Outpatient treatment information was gathered from Veterans Affairs databases. PTSD treatment and 12-Step group attendance in the 1st year predicted 5-year SUD remission. Patients who received PTSD treatment in the first 3 months following discharge and those who received treatment for a longer duration in Year 1 were more likely to be remitted in Year 5. The receipt of PTSD-focused treatment immediately after SUD treatment may enhance long-term remission.     

Longitudinal relationships of depressive symptoms to pain intensity and functional disability among children with disease-related pain

OBJECTIVE: To examine the longitudinal relationship between depressive symptoms at study entry (T1) on pain intensity (PI) and functional disability over a 1-year period among children with either sickle cell disease (SCD) or juvenile idiopathic arthritis (JIA). METHODS: 119 children, ages 8-17 years, completed measures of depression at T1 as well as pain and functional disability at T1, 6-month (T2), and 12-month (T3) follow-ups. Caregivers also rated their child's pain and disability at each time point. General linear mixed modeling was employed to examine longitudinal relationships between study variables. RESULTS: For children with JIA, T1 pain significantly moderated the effects of T1-depressive symptoms on T2 and T3 pain where T1-depressive symptoms predicted future child-reported pain only when T1 pain was relatively mild. Similarly, T1-depressive symptoms predicted future child-reported disability only when initial reports of disability were relatively low. Only family income significantly predicted T2 and T3 pain in children with SCD. CONCLUSIONS: Study findings suggest that T1-depressive symptoms play a role in the longitudinal course of pain symptoms in children with JIA but not in children with SCD.     

Homosexuality and illegal residency status in relation to substance abuse and personality traits among Mexican nationals

Maladaptive behavioral and personality reactions to severe stressors among Mexican homosexual men were assessed by comparing substance abuse and Rorschach data obtained from three samples: (a) homosexuals residing illegally in the United States (n = 40), (b) homosexuals living in Mexico (n = 21) and (c) heterosexuals living illegally in the United States (n = 25). The results of orthogonal contrasts showed very similar personality structure and substance abuse patterns among the participants in the two homosexual groups. As predicted, these men were found to be using alcohol or drugs to a greater extent than the heterosexual controls. Rorschach findings indicated that the homosexual subjects were experiencing dysphoric mood and distorted perceptions; they were also having significant difficulties coping with an environment that was discerned as increasingly dangerous. These results are relevant to the stress reduction hypothesis of addiction and provide quantitative information regarding the extent of psychopathology in this underserved Hispanic population.     

Assessment of PTSD symptoms in a community exposed to serial murder

This study examined the presence of PTSD symptoms across time in a community exposed to serial murder. One hundred eighty four subjects (48% response rate) responded to the initial survey while 64 and 30 subjects, respectively, participated in the 9- and 18-month follow-up studies. Results indicated widespread endorsement of PTSD symptoms following the murders. The most severe reactions were found among residents demographically similar to the victims. PTSD symptoms, while not transient, appeared to decrease over time with few subjects still reporting symptoms at 18 months. These data suggest that violent acts such as serial murder can have far reaching psychological consequences for the community and result in vicarious victimization. © 1997 John Wiley & Sons, Inc. J Clin Psychol 53: 809–815, 1997     

The relation of medical conditions to depressive symptoms among Latinos: leisure time physical activity as a mediator

Individuals with medical conditions report more depressive symptoms than those without such conditions. This study assessed whether physical activity (PA) plays a mediational role in the association between medical conditions and depressive symptoms among Latino adults. Adjusting for socioeconomic factors, those who reported having been diagnosed with diabetes, cardio-related disease, hypertension, high cholesterol, arthritis, or sleep problems endorsed more symptoms of depression. Vigorous PA mediated the relation between depressive symptoms and hypertension. In other words, people with hypertension who engaged in vigorous PA reported less depressive symptoms. PA may be a promising avenue for improving hypertension and depressive symptoms.     

The relation of season of birth to severity of menopausal symptoms

OBJECTIVE: Season of birth influences the rate of several psychiatric disorders. In this study, we investigated whether climacteric symptoms and, in particular, psychological and somatic symptoms of postmenopausal women were influenced by their season of birth. DESIGN: This retrospective multicenter study was performed on 2,541 women in natural menopause, free of hormone therapy. The score of the Greene Climacteric Scale and of its vasomotor, psychological (anxiety and depression), and somatization subscales were stratified by season of a woman's birth. Data were controlled for possible confounders, such as age, years since menopause, body mass index, education occupation, smoking habits, and season of evaluation. RESULTS: The Greene Climacteric Scale appeared to be associated with the season of birth, with the lowest scores being observed in women born in autumn and the highest scores in women born in spring (+2.11; 95% CI, 0.67-3.56; P = 0.01), and summer (+2.22; CI, 0.82-3.63; P = 0.01). Lowest scores in autumn and highest scores in spring were also observed for psychological symptoms subscaled as anxiety and depression (+1.43; CI, 0.54-2.32; P = 0.01) and somatic symptoms (+0.59; CI, 0.15-1.04; P = 0.01). CONCLUSIONS: In this study, we found a relationship between season of birth and some menopause-associated symptoms. Further study is needed to confirm these relationships and examine possible mechanisms.     

The minicolumnopathy of autism: A link between migraine and gastrointestinal symptoms

Gastrointestinal symptoms are common medical problems among autistic patients. A leaky gut and viruses have been proposed as possible culprits but evidence for these etiological agents remains elusive. In this article, we put forward an alternate etiology: abdominal migraines. Recent postmortem studies in autism indicate the presence of a minicolumnopathy and its relationship to both serotonergic abnormalities and a hyperexcitable cortex. These features of phenomenology are also observed in miganeurs. A putative relationship between autism and migraine is further suggested by similarities in clinical histories and laboratory evidence. Some commonalities include the presence of neuroinflammation, sensory overstimulation (e.g., flickering of fluorescent lights), "food allergies", benefits from similar diets, and the role of nitric oxide. Abdominal migraine therefore stands as a falsifiable hypothesis with added importance accrued to potential therapeutic interventions.     

The relation between coping,social support and psychological and somatic symptoms among torture survivors in Nepal

BACKGROUND: Little is known about the relation between coping, social support, and psychological and somatic symptoms among survivors of torture living outside the West. METHOD: In a population-based dataset of 315 tortured Bhutanese refugees, univariate and multivariate relationships between coping and social support and symptoms were estimated. These relationships were verified in a second sample of 57 help-seeking Nepalese torture survivors. RESULTS: A relationship was observed between the total number of coping strategies used and anxiety and depression. Negative coping, in contrast to positive coping, was related to all symptom outcome measures. Received social support was stronger related to symptoms than perceived social support. The findings from the first sample were replicated in the second sample. CONCLUSION: We found hypothesized relationships between coping, social support, and psychological and somatic symptoms among survivors of torture living in Nepal. The findings from this study confirm the importance of understanding specific types of coping and social support to develop intervention programmes for torture survivors in Non-western settings.     

艾滋病感染者中创伤后应激障碍的发病率及症状结构

目的:本研究考察我国艾滋病感染者中创伤后应激障碍的发病率及其症状结构。方法:样本1为云南省HIV感染者91名,样本2为该省和北京HIV感染者366名,施测自编创伤事件问卷及创伤后应激障碍检查表(PCLC),用DSM-Ⅳ轴Ⅰ障碍定式临床检查病人版(SCID-I)访谈对样本1被试进行诊断评估,确定PCL-C区分PTSD的分界点;用验证性因素分析比较PTSD症状结构的3个竞争模型。结果:1再体验-回避-麻木-警觉一阶四因子模型拟合最优;2PCL-C区分HIV感染者罹患PTSD的最佳分界点为44分,对应敏感度0.842,特异度0.906,诊断效能0.94,样本1中PTSD发病率为41.80%。结论:PTSD在HIV感染者人群中发病率高,PCL-C在该人群中呈一阶四因子一阶相关结构,提示该种症状分类具有跨样本一致性。