Trauma history and increased exposure to combat and sexual trauma may account for heightened rates of PTSD among military populations. This study assessed trauma type and exposure history, diagnostic ...impressions, and PTSD severity in a large clinical dataset (n = 2463) of veterans presenting for PTSD evaluation at a Midwestern VA Medical Center between the years 2006 and 2013. The degree of lifetime trauma exposure was pronounced, with approximately 76% of the sample reporting exposure to at least four traumatic events. Higher numbers of lifetime trauma and higher levels of combat exposure were associated with more severe PTSD symptoms. Sexual trauma and combat trauma were more predictive of PTSD than other trauma types. Sexual trauma was associated with more severe PTSD than combat and other trauma.
Objective: Advances in implementation science have encouraged novel methods for disseminating and implementing evidence-based treatments. Mental health services offered to trauma-exposed students on ...college campuses are characterized by unique contextual, developmental, and cultural factors that must be considered to effectively disseminate and implement trauma-focused, evidence-based treatments (TF-EBTs). Informed by novel implementation designs, this project utilized a strategic stakeholder engagement method of creating a learning community to identify and adapt a TF-EBT for use in university counseling centers (UCCs). Method: Project leads convened campus and community stakeholders included UCC clinicians, administrators, student life professionals, and students, to join researchers in a reciprocal collaboration to work toward dissemination and implementation. These stakeholders participated in a learning community that reviewed, selected, and adapted a TF-EBT and other tools for dissemination and implementation to UCCs and other campus professionals. Results: There were a number of benefits and challenges of using the learning community as a method of dissemination and implementation. Benefits included context-specific knowledge sharing, clarification of the scope of trauma among college students, creation of helpful tools, emphasis on cultural competence in TF-EBTs, and facilitating connections between professionals. Challenges included balancing flexibility with progress toward project goals and recruitment and retention of stakeholders. Conclusions: Stakeholder engagement is an integral component of dissemination and implementation efforts. The learning community method allowed for stakeholders to take an active part in adapting a TF-EBT for UCCs and can be utilized in other settings to aid in adoption and utilization of evidence-based treatments.
Clinical Impact Statement
Implementing evidence-based treatments into practice settings requires novel and collaborative methods of adapting treatments to be responsive to the specific contextual and cultural features of various practice settings. This article describes the use of a learning community method of implementation which brought together campus and researcher stakeholders for adapting a trauma-focused treatment to be offered in university counseling centers. This paper highlights the unique strengths and challenges of serving trauma-exposed students in university counseling centers and can be used to inform implementation in other types of setting as well.
Objective: Universities have demonstrated growing awareness of students impacted by interpersonal violence (e.g., sexual and physical assault) and veterans/service-members with combat-related trauma ...because of their sizable presence on campuses and unique vulnerabilities. This study sought to describe impacts of these two forms of trauma exposure on students' mental health and academic functioning and to compare mental health service utilization among students based on their experiences of trauma exposure. Method: To acquire a large, national sample of college students, we examined archival data from the Fall 2015 American College Health Association National College Health Assessment, a yearly, web-based survey which represented a sample of 19,861 students from 40 institutions. Results: Twenty percent of the students had experienced interpersonal victimization in the last 12 months, combat exposure, or both. Compared with other groups, interpersonal violence survivors reported the most negative impacts on mental health and interference with academic performance. Service utilization rates among trauma-exposed students ranged from 52% to 84%, and students who had experienced recent interpersonal violence were the most likely to have received services. Conclusions: With a national sample, this study confirms that trauma-exposed students report poor mental health. Service utilization is high among this population, but campus-based mental health services appear to remain underutilized. Outreach efforts by student life professionals and campus clinicians targeting demographic subgroups could enhance utilization and accessibility of campus resources.
Clinical Impact Statement
College campuses serve many students who have faced highly stressful and traumatic experiences such as physical and sexual assault and student veterans/service members who have been in combat. This study describes the way that these experiences interfere with the emotional health and academic performance of students. Results showed that certain groups of trauma-exposed students experience a number of negative impacts and are more likely to seek help from mental health professionals than the general population. Findings suggest that efforts should be made to improve the use of campus-based mental health services.
To identify how cardiomyocyte mechanosensitive signaling pathways are regulated by anisotropic stretch, micropatterned mouse neonatal cardiomyocytes were stretched primarily longitudinally or ...transversely to the myofiber axis. Four hours of static, longitudinal stretch induced differential expression of 557 genes, compared with 30 induced by transverse stretch, measured using RNA-seq. A logic-based ordinary differential equation model of the cardiac myocyte mechanosignaling network, extended to include the transcriptional regulation and expression of 784 genes, correctly predicted measured expression changes due to anisotropic stretch with 69% accuracy. The model also predicted published transcriptional responses to mechanical load in vitro or in vivo with 63-91% accuracy. The observed differences between transverse and longitudinal stretch responses were not explained by differential activation of specific pathways but rather by an approximately twofold greater sensitivity to longitudinal stretch than transverse stretch. In vitro experiments confirmed model predictions that stretch-induced gene expression is more sensitive to angiotensin II and endothelin-1, via RhoA and MAP kinases, than to the three membrane ion channels upstream of calcium signaling in the network. Quantitative cardiomyocyte gene expression differs substantially with the axis of maximum principal stretch relative to the myofilament axis, but this difference is due primarily to differences in stretch sensitivity rather than to selective activation of mechanosignaling pathways.
Anisotropic stretch applied to micropatterned neonatal mouse ventricular myocytes induced markedly greater acute transcriptional responses when the major axis of stretch was parallel to the myofilament axis than when it was transverse. Analysis with a novel quantitative network model of mechanoregulated cardiomyocyte gene expression suggests that this difference is explained by higher cell sensitivity to longitudinal loading than transverse loading than by the activation of differential signaling pathways.
Adolescents who experience negative life events may be at risk for depression, particularly those with psychosocial vulnerabilities. We investigate longitudinally the impact of ...vulnerability/protective factors on the relation between a large-scale negative life event, the COVID-19 pandemic, and depressive symptoms. Adolescents (N = 228, M
age
= 14.5 years, 53% female, 73% white) self-reported depressive symptoms 2–4 months before the pandemic (Time 1), and again 2 months following stay-at-home orders (Time 2). At T2, adolescents also completed measures of vulnerability, protective factors, and COVID-19-related distress. Depressive symptoms increased at T2, and COVID-19 distress interacted with resilience and negative cognitive style in predicting increases in T2 depression. Focusing on vulnerability and protective factors in adolescents distressed by large scale negative life events appears crucial.
Approximately 20% of people will experience a depressive episode by adulthood, making adolescence an important developmental target for prevention. CATCH-IT (Competent Adulthood Transition with ...Cognitive-behavioral, Humanistic, and Interpersonal Training), an online depression prevention intervention, has demonstrated efficacy in preventing depressive episodes among adolescents reporting elevated symptoms. Our study examines the effects of CATCH-IT compared to online health education (HE) on internalizing symptoms in adolescents at risk for depression. Participants, ages 13-18, were recruited across eight US health systems and were randomly assigned to CATCH-IT or HE. Assessments were completed at baseline, 2, 6, 12, 18, and 24 months. There were no significant differences between groups in change in depressive symptoms (b = -0.31 for CATCH-IT, b = -0.27 for HE,
= 0.80) or anxiety (b = -0.13 for CATCH-IT, b = -0.11 for HE,
= 0.79). Improvement in depressive symptoms was statistically significant (
< 0.05) for both groups (
= 0.004 for CATCH-IT,
= 0.009 for HE); improvement in anxiety was significant for CATCH-IT (
= 0.04) but not HE (
= 0.07). Parental depression and positive relationships with primary care physicians (PRPC) moderated the anxiety findings, and adolescents' externalizing symptoms and PRPC moderated the depression findings. This study demonstrates the long-term positive effects of both online programs on depressive symptoms and suggests that CATCH-IT demonstrates cross-over effects for anxiety as well.
College and university students across the United States are experiencing increases in depressive symptoms and risk for clinical depression. As college counseling centers strive to address the ...problem through wellness outreach and psychoeducation, limited resources make it difficult to reach students who would most benefit. Technology-based prevention programs have the potential to increase reach and address barriers to access encountered by students in need of mental health support. Part 1 of this manuscript describes the development of the Willow intervention, an adaptation of the technology-based CATCH-IT depression prevention intervention using a community participatory approach, for use by students at a women’s liberal arts college. Part 2 presents data from a pilot study of Willow with N = 34 (mean age = 19.82, SD = 1.19) students. Twenty-nine participants (85%) logged onto Willow at least once, and eight (24%) completed the full intervention. Participants positively rated the acceptability, appropriateness, and feasibility of Willow. After eight weeks of use, results suggested decreases in depressive symptoms (95% CI (0.46–3.59)), anxiety symptoms (95% CI (0.41–3.04)), and rumination (95% CI (0.45–8.18)). This internet-based prevention intervention was found to be acceptable, feasible to implement, and may be associated with decreased internalizing symptoms.
Abstract Background Risk factors of violence perpetration in veterans include substance use and posttraumatic stress disorder (PTSD); however, it is unknown whether these factors are associated with ...greater risk for partner or non-partner violence. This study investigated the associations between probable PTSD, heavy drinking, marijuana use, cocaine use, and partner and non-partner violence perpetration. Methods Self-report questionnaires assessing past-year partner and non-partner aggression (CTS2) as well as past-month substance use (SAOM) , probable PTSD (PCL C) , and probable depression (PHQ-9) were administered to 810 substance using veterans entering VA mental health treatment. Results In bivariate analyses, probable PTSD in substance using veterans was associated with violence perpetration (partner physical, χ2 = 11.46, p = 0.001, φ = 0.12; non-partner physical, χ2 = 50.64, p < 0.001, φ = 0.25; partner injury, χ2 = 6.41, p = 0.011, φ = 0.09; non-partner injury, χ2 = 42.71, p < 0.001, φ = 0.23). In multiple logistic regression analyses that adjusted for sociodemographic characteristics , probable PTSD was independently associated with non-partner physical (odds ratio OR , 2.82; 95% confidence interval CI, 1.97–4.05) and injury aggression ( OR , 3.96; CI, 2.56–6.13). Cocaine and heavy drinking were independently associated with non-partner physical and injury aggression and non-partner injury aggression respectively. Conclusions The results provide evidence that probable PTSD, heavy drinking, and cocaine use are associated with increased risk of non-partner violence perpetration in substance using veterans. These results underscore the importance of screening for PTSD symptoms and violence perpetration towards non-partners in substance using veterans presenting for treatment.
With as many as 13% of adolescents diagnosed with depressive disorders each year, prevention of depressive disorders has become a key priority for the National Institute of Mental Health (NIMH). ...Currently, we have no widely available interventions to prevent these disorders. To address this need, we developed a multi-health system collaboration to develop and evaluate the primary care based technology “behavioral vaccine,” Competent Adulthood Transition with Cognitive-Behavioral Humanistic and Interpersonal Therapy (CATCH-IT). The full CATCH-IT program demonstrated evidence of efficacy in prevention of depressive episodes in clinical trials. However, CATCH-IT became larger and more complex across trials, creating issues with adherence and scalability.
We will use a multiphase optimization strategy approach to optimize CATCH-IT. The theoretically grounded components of CATCH-IT include: behavioral activation, cognitive-behavioral therapy, interpersonal psychotherapy, and parent program. We will use a 4-factor (2x2x2x2) fully crossed factorial design with N = 16 cells (25 per cell, after allowing 15% dropout) to evaluate the contribution of each component. Eligible at-risk youth will be high school students 13 through 18 years old, with subsyndromal symptoms of depression. The study design will enable us to eliminate non-contributing components while preserving efficacy and to optimize CATCH-IT by strengthening tolerability and scalability by reducing resource use. By reducing resource use, we anticipate satisfaction and acceptability will also increase, preparing the way for an implementation trial.
Post-Traumatic Stress Disorder (PTSD) is characterized by distinct behavioral and physiological changes. Given the significant impairments related to PTSD, examination of the biological underpinnings ...is crucial to the development of theoretical models and improved treatments of PTSD.
We used an attentional interference task using emotional distracters to test for top-down versus bottom-up dysfunction in the interaction of cognitive-control circuitry and emotion-processing circuitry. A total of 32 women with PTSD (based on an interpersonal trauma) and 21 matched controls were tested. Event-related functional magnetic resonance imaging was carried out as participants directly attended to, or attempted to ignore, fear-related stimuli.
Compared to controls, patients with PTSD showed hyperactivity in several brain regions, including the amygdala, insula, as well as dorsal lateral and ventral PFC regions.
These results are consistent with previous studies that have higher amygdala and insular activation in PTSD subjects. However, inhibition of suppression of PFC regions is inconsistent with the fear circuitry model hypothesized by prior research. We suggest that the specific emotional conflict task used appears to target implicit or automatic emotional regulation instead of explicit or effortful emotional regulation. This is particularly relevant as it posited that emotional regulatory difficulties in anxiety disorders such as PTSD appear to occur in implicit forms of emotion regulation.
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