Given their sudden onset and life-threatening consequences, strokes and transient ischemic attacks (TIAs) can trigger posttraumatic stress disorder (PTSD). To gain a deeper understanding of the potential influence of factors in patients' descriptions of these medical events on PTSD, we conducted a standardized trauma interview with a convenience sample of patients hospitalized for suspected stroke/TIA (N = 98) to assess the details and emotional experience of the stroke/TIA event. Three researchers reviewed the interviews and the research literature on risk and protective factors for PTSD. From this analysis, a codebook with descriptions, examples, and scoring protocols for eight Likert scale, two categorical, and four binary codes was developed. Upon demonstrating sufficient interrater reliability, the research team scored all narratives. Three superordinate themes were identified in the analysis: distress (e.g., fear, helplessness), potential protective factors (e.g., positive expectancies, concern for loved ones), and level of detail (e.g., somatic detail, emotional detail). Differences in perceptions, themes, and expectations emerged in the narratives, indicating a wide range of responses following stroke/TIA. Additionally, patient age was negatively correlated with scores for the fear, r = -.34, p < .001, and negative consequences, r = -.24, p = .018, codes and positively associated with the likelihood of having positive expectancies, OR = 1.05, 95% CI [1.00, 1.10], p = .039. These findings provide a more comprehensive understanding of how patients reflect on their experiences post-stroke/TIA and can inform future research on the contributions of trauma narrative characteristics and emotional responses to PTSD risk.

Negative mental health outcomes are prevalent among veterans exposed to military-related stressors and are associated with social isolation. Limited research exists on resilience following military separation and its impact on social isolation in veterans. We examined resilience against military-related stressors and 2-year longitudinal associations with social isolation indicators; gender differences were also explored. U.S. military veterans (N = 351, 70.4% men) who deployed to the wars in and around Iraq and Afghanistan following the September 11, 2001, terrorist attacks (9/11) were recruited as part of a longitudinal assessment study examining predictors of postdeployment adjustment. Using a residualization approach, resilience was approximated as low stressor reactivity (SR), calculated by regressing mental health onto military-related stressor exposure. Military-related stressors were significantly associated with posttraumatic stress disorder (PTSD) related to both events during post-9/11 deployment (deployment event) and outside of post-9/11 deployment (other event), functional disability, and depression. After correcting for multiple comparisons, only SR derived from depressive symptoms predicted more closeness difficulties in social relationships longitudinally, B = 0.50, q = .023. Women also demonstrated higher SR than men regarding other event-related PTSD symptoms, B = -0.52, q < .001; functional disability, B = -0.28, q = .028; and depression, B = -0.34, q = .012. Results suggest that veterans with higher depressogenic reactivity to military-related stressors were more likely to endorse discomfort with closeness than those with lower depressogenic reactivity. Women veterans may also be more impacted by nondeployment traumatic distress, psychosocial dysfunction, and depression in response to military-related stressors.

Few studies have considered the influence of cultural factors on the associations between posttraumatic stress disorder (PTSD) and key emotion regulation strategies, such as expressive suppression and reappraisal. This study investigated the influences of cultural background and self-construal orientation on PTSD symptoms and both suppression and reappraisal. Chinese Australian (n = 129) and European Australian (n = 140) trauma survivors completed an online survey assessing suppression and reappraisal (Emotion Regulation Questionnaire), cultural values (Self Construal Scale), and PTSD symptoms (PTSD Checklist for DSM-5). We hypothesized that participants in the Chinese Australian group would report higher levels of suppression and reappraisal than those in the European Australian group and that self-construal and cultural group would moderate both the associations between PTSD symptoms and both suppression reappraisal. Correlation and moderation analyses were performed to examine these hypotheses. Chinese Australian participants reported higher levels of reappraisal than European Australian participants, η  = .05, p < .001. Regardless of cultural group, there was no significant association between reappraisal and PTSD symptoms, B = 0.10, p = .849, 95% CI [-0.93,1.13]. Cultural group and self-construal moderated the association between suppression and PTSD symptoms, ΔR = .02, p = .007, whereas a positive association was observed between suppression and PTSD symptoms; however, this association was not significant for Chinese Australians who endorsed higher levels of interdependence. These findings suggest that suppression may be less strongly associated with PTSD symptoms for Chinese Australians who value interdependence. This finding highlights the importance of considering cultural values in PTSD treatment approaches.

Social support is protective in the recovery from mental health diagnoses. However, well-intended support can also interfere with treatment, as in the case of accommodation, when a support person changes their behaviors to alleviate a patient's distress. This paper describes a scoping review of the research literature regarding posttraumatic stress symptoms (PTSS) and accommodation, conducted using the Preferred Reporting Items extension for Scoping Review Guidelines (PRISMA-ScR). A total of 26 articles were included in the review. Designs and settings were mixed, but most studies examined accommodation by female adult intimate partners of male military members, veterans, and first responders with PTSS. Most participants were White. Accommodation was typically associated with negative relationship outcomes, and some couples treatments (e.g., cognitive behavioral conjoint therapy interventions) were associated with improvements in PTSS accommodation. Future work on PTSS accommodation should prioritize recruiting more diverse participants (i.e., gender, race, ethnicity, military status, types of support people). In addition, researchers should continue to examine accommodation as a mediator or moderator variable. Further examination of accommodation and PTSS may provide helpful insights into the involvement of support people in treatment to increase treatment effectiveness.

Attentional bias and deficits in attentional control are associated with posttraumatic stress disorder (PTSD) symptoms. Attention control training (ACT) may address these factors. We reviewed randomized controlled trials (RCTs) of ACT for PTSD to address unanswered questions about ACT's effectiveness, tolerability, and implementation. Studies were included if they were an RCT that used an adult sample, recruited participants with a PTSD diagnosis, and had ACT as at least one treatment arm. The PTSD Trials Standardized Data Repository (PTSD-Repository) and additional databases were searched to identify PTSD RCTs published through May 2024. Seven studies met the inclusion criteria (N = 407). The effect size for ACT versus a comparison condition on PTSD symptoms was large, but the confidence interval (CI) overlapped with 0, g = 0.75, 95% CI [-0.63, 2.12]. The same pattern was observed for attention bias variability, g = 1.04, 95% CI [-0.90, 2.98]. There was a significant within-group effect of ACT on self-reported PTSD symptoms, g = -1.43, 95% CI [-2.83, -0.03]. Risk of bias varied, with high risk of bias being primarily due to bias in the measurement of the outcome. These effects should be interpreted cautiously given the significant heterogeneity and wide confidence intervals observed. It remains unclear for whom and under what conditions ACT may be most effective. Future studies should move beyond response time measures, employ an inactive comparator, and examine the mechanism of action to determine whether ACT could be a viable intervention for PTSD.

Prior research has rarely examined how people understand or react to the names of psychological treatments. In the case of evidence-based psychotherapies for posttraumatic stress disorder (PTSD), such reactions may be relevant to the low rates of uptake of such treatments. Participants who screened positive for PTSD (n = 887) completed questions assessing their initial reactions to PTSD treatment names as well as how a different name would affect their openness to treatment. In addition, they gave brief responses to open-ended questions about the reason for their initial reactions, and content analysis was used to better understand these reasons. The results indicated that among the treatment name options, cognitive processing therapy (CPT) and present-centered therapy (PCT) were viewed most positively. Approximately 40% of the sample preferred plain language alternatives for treatment names. Content analyses focused on descriptions of the treatments-which could be accurate or inaccurate-as well as whether respondents evaluated a treatment name itself as positive or negative. Some names conveyed treatments more accurately (e.g., CPT and written exposure therapy) than others (e.g., eye movement desensitization and reprocessing and prolonged exposure [PE]). Some names were also evaluated more positively (e.g., PCT) than others (e.g., PE). The general term "trauma-focused therapy" was seen as positive and clear. Addressing the ways patients react to psychological terms and treatment names could help clarify misperceptions about evidence-based psychotherapies and promote more widespread uptake of effective treatments for PTSD.

At the 39th meeting of the International Society of Traumatic Stress Studies, three leading researchers and clinicians in technology-enabled traumatic stress support were invited to reflect on their careers and contributions to the field. Dr. Brian P. Marx has led the development of large-scale technologies to screen, assess, and treat traumatic stress pathology across diverse etiologies and needs. Dr. Barbara O. Rothbaum, a pioneer in the development of virtual reality for exposure therapy, has demonstrated the efficacy and scalability of digital treatment for traumatic stress. Retired Col. Dr. Eric Vermetten has worked extensively on the intersection of basic mechanisms, novel psychological and biological treatment, and technology for scalable assessment and treatment, primarily in military and mass casualty contexts. The panelists were asked to reflect on their initial ambitions, concerns, unexpected challenges, and the influence of their work on new research trajectories. Their insights provide valuable lessons about the process and content of their work, and their pioneering efforts have significantly advanced the field of technology-enabled traumatic stress support.

Posttraumatic stress disorder (PTSD) often occurs following mass casualty events, yet the connection between the number of individuals injured in an event and PTSD risk in smaller-scale events (i.e., involving one or several injured persons) remains unclear. We conducted a registries-based study cross-referencing three databases across the continuum of care for military trauma patients hospitalized for traumatic injuries. The study population was categorized into three groups based on the number of injured individuals involved (i.e., single injured person, two to four [2-4] injured people, and five or more [≥ 5] injured people), and PTSD prevalence was assessed using long-term disability claim diagnoses. Overall, 4,030 military personnel were included (age at injury: Mdn = 20 years), and 18.3% were subsequently diagnosed with PTSD, with the highest prevalence in events involving ≥ 5 injured individuals (35.8%). Regression analyses adjusted for potential confounders revealed that being injured in an event with 2-4 injured persons, OR = 1.68, 95% CI [1.31, 2.15], or ≥ 5 injured persons, OR = 2.36, 95% CI [1.79, 3.13], was associated with increased odds of developing PTSD compared to being the sole injured person. The findings suggest a direct association between the number of injured individuals in an event and PTSD prevalence among traumatic injury survivors. The results underscore the importance of early diagnosis and interventions to prevent PTSD in individuals injured in multicasualty and mass casualty events.

Cognitive processing therapy (CPT) is a well-known trauma-focused treatment that aims to generate more adaptive posttrauma cognitions and emotions. Changes in cognitions are theorized to be the mechanism by which CPT leads to improvement in posttraumatic stress disorder (PTSD) symptoms. The present study aimed to explore associations between changes in PTSD symptom clusters during CPT. We hypothesized that early changes in negative alterations in cognitions and mood (NACM) would correlate with later changes in other symptom clusters. Data were collected from 296 veterans participating a 7-week PTSD residential treatment program at a U.S. Veterans Affairs medical center. PTSD symptoms were assessed at pretreatment (Week 1), midtreatment (Week 4), and posttreatment (Week 7). Cross-lagged path analyses demonstrated that pretreatment-to-midtreatment improvement in NACM was correlated with midtreatment-to-posttreatment improvement in avoidance, β = .52, though this association was bidirectional, suggesting pretreatment-to-midtreatment improvements in either cluster may be correlated with midtreatment-to-posttreatment improvements. Similarly, pretreatment-to-midtreatment improvement in intrusions, β = .40, and arousal, β = .49, were correlated with later improvement in avoidance, suggesting avoidance may improve after improvement in other clusters. Interestingly, pretreatment-to-midtreatment arousal improvement was significantly correlated with midtreatment-to-posttreatment NACM improvement, β = .27, though the reverse was nonsignificant, whereas a bidirectional association between arousal and intrusions emerged, β = .34, β = .53. Early changes in arousal were correlated with later changes in several other symptom clusters, whereas other clusters demonstrated bidirectional associations. These results may inform understanding of symptom improvement timing across CPT, which may aid in treatment selection and planning.

This editorial summary provides an overview of the 39th annual meeting of the International Society for Traumatic Stress Studies (ISTSS) held from November 1-4, 2023. The meeting, themed "Scalable Strategies to Address the Impact of Trauma Worldwide: Innovations and Implementation," encouraged presenters to focus on the scalability of traumatic stress research and practice. The articles presented at the meeting, which form this issue, cover a broad spectrum of topics, from basic biological mechanisms to innovative digital engagement to population-wide treatments. These articles emphasize eliminating biases in research design and psychiatric practice, promoting health equity, and addressing the unique challenges of traumatic stress. This summary underscores the importance of scalability in developing flexible, dynamic, and inclusive mental health care interventions.

Few studies have examined anger concerns among postpartum women despite their risk of mood dysregulation. This study examined the performance of the Dimensions of Anger Reactions-5 (DAR-5) scale, a brief screen for problematic anger, in a sample of 1,383 postpartum women in Wisconsin who received perinatal home visiting services. We aimed to analyze the discriminant validity and measurement invariance of the DAR-5, the occurrence of problematic anger symptoms and their co-occurrence with mental health concerns, and the association between elevated anger levels and exposure to potentially traumatic events in childhood and adulthood. Descriptive statistics for anger symptoms and their associations with depression, anxiety, and PTSD were calculated. Psychometric properties of the DAR-5 were assessed via confirmatory factor analyses, and associations between trauma exposure and anger were evaluated as bivariate and partial correlations. Approximately 21% of the sample exhibited problematic anger based on an established DAR-5 cutoff score (≥ 12). Anger symptoms co-occurred with posttraumatic stress disorder (PTSD), depressive, and anxiety symptoms, though the DAR-5 sufficiently distinguished anger from these correlated symptom profiles. The DAR-5 also demonstrated acceptable measurement invariance across levels of trauma exposure. Higher levels of trauma exposure in childhood and adulthood significantly increased the risk of problematic anger even after controlling for PTSD, anxiety, and depressive symptoms, partial range: .07-.16. The findings suggest the DAR-5 is a valid brief screen for anger in postpartum women. Increased attention should be paid to elevated anger and the co-occurrence of other mental health concerns following childbirth.

At the 39th meeting of the International Society of Traumatic Stress Studies, four leading scientists and clinicians were invited to reflect on their careers, focusing on the biological mechanisms and markers of traumatic stress. Dr. Raul Andero has contributed to understanding how stress alters memory networks in the brain, influencing the development of novel treatments. Dr. Tanja Jovanovic has pioneered the measurement and mechanistic understanding of fear learning, bridging basic and clinical research. Dr. Murray B. Stein has scaled up clinical and lab observations to large populations, refining the field's understanding of traumatic stress. Dr. Arieh Y Shalev has shaped the definition of traumatic stress, pioneering the longitudinal investigation of stress and integrating advanced computational methods to identify individuals at risk. These panelists were asked to reflect on their initial problems, ambitions, concerns, and unexpected challenges, as well as the influence of their work, on new research trajectories. Their insights provide valuable lessons about the process and content of their work, and their pioneering efforts have significantly advanced our understanding of the biological mechanisms and markers of traumatic stress.

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.

Though social support (SS) and communal mastery (CM) are resilience factors among American Indian and Alaska Natives (AIAN), they have not been examined as trauma treatment predictors in this at-risk group. This study evaluated whether SS and CM were associated with improved treatment response in a sample of 73 AIAN women with posttraumatic stress disorder (PTSD) symptoms. Participants received culturally adapted CPT and were assessed for PTSD, CM, and SS. Data were analyzed using linear mixed-effects models. SS predicted improved PTSD, β = -.16, SE = .05, p = .003, and mental health, β = .16, SE = .05, p = .005, but not physical health. CM predicted improved PTSD, β = -.93, SE = .34, p = .008; mental health, β = .90, SE = .36, p = .013; and physical health, β = .95, SE = .31, p = .003. In a combined model, SS predicted improvements in PTSD, β = -.15, SE = .04, p < .001, and mental health, β = .12, SE = .06, p = .037, whereas CM did not. CM predicted improved physical health, β = 1.04, SE = .33, p = .003, whereas SS did not. Results highlight the benefits of SS and CM in trauma treatment outcomes for AIAN women, consistent with prior work, and further underscore the differential role of SS versus CM on mental versus physical health. Future work should explore how orientation to close and communal-level relationships may inform the protective benefits of social resources among AIAN.

Anger can adversely impact functioning in veterans. Psychological aggression, which is related to but distinct from anger, is particularly detrimental to veterans' mental health. Research examining anger and psychological aggression following individual therapy for posttraumatic stress disorder (PTSD) has demonstrated small effect sizes. Treatments that directly target conflict management and interpersonal functioning, both regarding content and delivery to veterans and their loved ones (e.g., couples-based PTSD treatments), may be more effective in alleviating anger symptoms. This study examined whether larger reductions in anger and psychological aggression would be observed in a couples-based intervention compared to an active comparator at posttreatment and follow-up. Data were derived from a randomized trial comparing brief cognitive-behavioral conjoint therapy for PTSD (bCBCT) and PTSD family education (PFE). Participants were 137 veterans and their intimate partners (bCBCT: n = 92, PFE: n = 45). We observed within-condition significant reductions in angry temperament, d = -0.47, p < .001, and angry reaction, d = -0.26, p = .004, among veterans in bCBCT but not PFE, |d|s = 0.13-0.17, ps = .166-.268. Veterans and partners in both conditions reported reductions in psychological aggression, |d|s = 1.09-1.46, ps < .001. There were no significant differences between the treatment conditions on any outcome, ps = .103-.443, and there were no significant changes in anger between posttreatment and follow-up, |d|s = 0.07-0.24, ps = .052-.582. Couples-based interventions for PTSD, including bCBCT and PFE, can be effective in improving aspects of anger among veterans and their intimate partners.

The PTSD Checklist for DSM-5 (PCL-5) is the most widely used self-report measure of posttraumatic stress disorder (PTSD) and is frequently modeled as having four correlated factors consistent with the DSM-5 symptom structure. Some researchers have argued that item order may influence factor structure. Although two studies have examined this, they were both based on DSM-IV criteria, and neither utilized a randomized design. Thus, this study aimed to determine whether item order impacts the factor structure of the PCL-5, using two independent samples of community participants (N = 347, 67.7% female, 85.3% White) and veterans (N = 409, 83.6% male, 61.9% Black/African American). Approximately half of each sample was randomized to receive the PCL-5 in the original fixed order, whereas the other half received a uniquely randomized version. We compared the DSM-5 four-factor model to several theoretically relevant models and found improved model fit in the seven-factor hybrid model, community sample: ∆χ = 153.87, p < .001; veterans: ∆χ = 152.61, p < . 001. Consequently, the DSM-5 four-factor and seven-factor hybrid models were retained for invariance testing. Across both samples, measurement invariance was examined between the randomized and fixed-order groups. Configural invariance, partial metric invariance, and partial scalar invariance were achieved in both samples, ps = .054-.822, suggesting that the fit of the DSM-5 four-factor structure and the seven-factor hybrid model, as measured using the PCL-5, are not due to order effects. These findings support the continued use of the PCL-5 in a fixed fashion.

Bisexual+ (e.g., bisexual, pansexual, queer) women experience higher rates of sexual violence (SV) and posttraumatic stress disorder (PTSD) than heterosexual and lesbian women, as well as unique identity-related minority stress. We examined between- and within-person associations between bisexual minority stress and PTSD symptoms related to SV in a sample of young bisexual+ women (N = 133) who reported adult SV (M = 22.0 years, range: 18-25 years; 85.0% White; 99.3% cisgender). We analyzed data from four waves of data collection (baseline to 3-month follow-up) using multilevel models. Controlling for SV severity, there was a significant within-person effect of antibisexual stigma from lesbian/gay people on PTSD, β = .17, p = .010, suggesting that at waves when women experienced more stigma, they also reported higher PTSD symptom levels. At the between-person level, women who reported higher levels of antibisexual stigma from heterosexual people, β = .26, p = .043, and anticipated binegativity, β = .29, p = .005, on average across study waves also reported higher average levels of PTSD. Additionally, anticipated binegativity explained the association between average antibisexual stigma and PTSD, β = .15, p = .014, 95% CI [0.45, 4.61]. Bisexual minority stress may be associated with higher PTSD symptom severity following SV among young bisexual+ women, and the anticipation of binegativity may be a target mechanism in this association. Study findings highlight the importance of examining the joint contributions of SV and minority stress to identify novel targets for future research and practice to address PTSD symptoms.

Adverse childhood experiences (ACEs) are often associated with higher rates of mental health issues and problematic behaviors within the U.S. college population. Therefore, the primary purpose of this study was to investigate the current associations among ACEs, six psychosocial risk factors for poor health (i.e., anxiety, depression, loneliness, negative urgency, positive urgency, and stress), and significant behavioral and substance problems in a large sample of college students (N = 1,993). Overall, 72.3% of participants reported one or more ACEs, with 21.7% reporting at least five of these experiences; the most prevalent ACE types were emotional abuse (51.7%) and parental mental illness (33.8%). Cumulative ACEs were positively associated with all health risk factors, rs = .07-.38, ps ≤ .001, and these ACE scores were most connected to student problems with alcohol, overeating, and sex, rs = .19-.22, ps < .001. Furthermore, using logistic regression, cumulative ACEs predicted which students were more likely to report behavioral problems, OR = 1.08, 95% CI [1.03, 1.14]; substance problems, OR = 1.16, 95% CI [1.07, 1.26]; and both types of problems, OR = 1.28, 95% CI [1.20, 1.36], relative to students without these problems. Aside from ACEs, higher anxiety was the only other risk factor all three problem types shared. Collectively, these findings highlight the differential impact of ACEs and other psychosocial risk factors on the susceptibility of college students to particular forms of maladaptive coping and suggest potential targets for intervention and prevention efforts in these areas.

Between 44% and 87% of active duty service members and veterans who deployed following the September 11, 2001, terrorist attacks know someone who was killed or seriously injured in combat. Considering the high frequency and known impact of traumatic loss, it is important to understand if and how traumatic loss may impede posttraumatic stress disorder (PTSD) treatment progress in military personnel. Additionally, experiencing a traumatic loss elevates the risk of developing prolonged grief disorder (PGD), which is associated with higher levels of PTSD symptoms, more functional impairment, and more lifetime suicide attempts among military personnel. Given what is known about the association between PGD and PTSD in treatment-seeking service members and veterans, it is also important to understand whether grief-related symptom severity negatively impacts PTSD treatment response. The current study examined associations among traumatic loss, complicated grief, depressive symptoms, and PTSD treatment response among military personnel (N = 127) who participated in variable-length cognitive processing therapy (CPT). There was no direct, F(2, 125) = 0.77, p = .465, or indirect, β = .02, p = .677, association between a traumatic loss index event and PTSD treatment response compared with other trauma types. Prior assessments of depressive symptom severity were directly related to PTSD at later assessments across two models, ps < .001-p = .021 Participants with a traumatic loss index trauma demonstrated significant reductions in complicated grief, depressive symptoms, and PTSD following CPT, ps < .001, ds = -0.61--0.83. Implications, study limitations, and suggestions for future research are presented.

Posttraumatic stress disorder (PTSD) is associated with poor quality of life. Although randomized clinical trial data show improvements in quality of life following trauma-focused therapies (TFTs), including prolonged exposure therapy (PE) and cognitive processing therapy (CPT), less is known about how these improvements are experienced from the trauma survivor's perspective. A national sample of 60 veterans who recently completed TFT as part of routine care at U.S. Department of Veterans Affairs facilities participated in semistructured qualitative interviews during which the impact of treatment on quality of life was explored. Following a mixed deductive/inductive approach, six interrelated themes describing changes in quality of life emerged: full participation in social activities, greater emotional intimacy in relationships, improvements in parenting, expanded engagement in hobbies and community, increased occupational commitment and confidence, and more joy in life. The data highlight the positive impact of treatment on quality of life and provide depth to quantitative findings demonstrating improvements in quality of life following TFT.

Although collective violence represents a significant public health concern, a limited number of longitudinal studies have addressed this topic, with no systematic reviews focusing on posttraumatic stress symptom (PTSS) trajectories. The present systematic review and meta-analyses examined PTSS prevalence and trajectories after exposure to collective violence. A systematic literature search across six databases (APA PsycInfo, APA PsycArticles, PSYINDEX, MEDLINE, ERIC, and PubMed) identified 771 studies that were screened for the following eligibility criteria: exposure to collective violence, adult sample, longitudinal design, PTSS assessment using validated measures, PTSS trajectories estimated using latent growth modeling, and report sample prevalence rate for each trajectory. Ten studies met the criteria, and five meta-analyses were performed to assess the overall prevalence of each trajectory. Most included studies (63.6%) identified four trajectories, characterized as low-stable, high-stable, decreasing, and delayed-worsening. The low-stable trajectory was the modal response, with a pooled prevalence of 58.0%, 95% CI [51.0, 65.0]. The high-stable prevalence was 7.0%, 95% CI [4.0, 19.0]; the decreasing trajectory was 13%, 95% CI [9.0, 17.0]; and the delayed-worsening trajectory was 8.0%, 95% CI [5.0, 10.0]. A fifth trajectory, moderately stable, had a prevalence of 19.0%, 95% CI [9.0, 29.0]. The trajectory models robustly identified clinically relevant patterns of response to collective violence, offering a contribution to the literature and a starting point for future research. Further studies are needed, as a better comprehension of symptom trajectories after collective violence events has important clinical and public health implications.

Distress tolerance, or the perceived ability to tolerate negative emotional states, is often associated with posttraumatic stress disorder (PTSD) such that higher distress tolerance is generally associated with less severe PTSD symptom levels. As distress tolerance is often considered a risk and maintenance factor in distress disorders, examining the association between changes in distress tolerance and changes in PTSD symptoms may have clinical relevance. The present study examined the associations between PTSD symptom severity and distress tolerance across three assessment points over 12 weeks among 212 patients receiving outpatient psychotherapy services. Using random-intercept cross-lagged panel modeling (RI-CLPM), concurrent and prospective associations between PTSD and distress tolerance were examined. PTSD symptoms at Time 1 and Time 2 significantly predicted distress tolerance at Time 2, β = -.296, and Time 3, β = -.395, respectively. Distress tolerance did not predict subsequent PTSD symptom severity. Exploratory analyses examined distress tolerance and four PTSD symptom clusters over time. Patterns of results differed across clusters, though it was consistent that only PTSD symptom clusters predicted subsequent distress tolerance and not vice versa. The results support the interrelationship of changes in psychopathology and emotional distress tolerance and indicate that distress tolerance may be an important factor in symptom remission during PTSD treatment.

The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) is a widely used, well-validated structured interview for posttraumatic stress disorder (PTSD). It was recently revised to improve various aspects of administration and scoring. We conducted a psychometric evaluation of the revised version, known as the CAPS-5-R. Participants were 73 community residents with mixed trauma exposure (e.g., sexual assault, physical assault, transportation accident, the unnatural death of a loved one). CAPS-5-R PTSD diagnosis demonstrated good test-retest reliability, кs = .73-.79; excellent interrater reliability, кs = .86-.93; and good-to-excellent alternate forms reliability with the CAPS-5, кs = .79-.93. In addition, the CAPS-5-R total PTSD severity score demonstrated excellent test-retest reliability, intraclass correlation coefficient (ICC) = .86; interrater reliability, ICC = .98; and alternate forms reliability with the CAPS-5, r = .95. Further, the CAPS-5-R demonstrated good convergent validity with other measures of PTSD and good discriminant validity with measures of other constructs (e.g., depression, anxiety, alcohol problems, somatic concerns, mania). Given its strong psychometric performance in this study, as well as its improvements in administration and scoring, the CAPS-5-R appears to be a valuable update of the current CAPS-5.

Psychological assessment is commonly conducted using either self-report measures or clinical interviews; the former are quick and easy to administer, and the latter are more time-consuming and require training. Self-report measures have been criticized for producing higher estimates of symptom and disorder presence relative to clinical interviews, with the assumption being that self-report measures are prone to Type 1 error. Here, we introduce the use of "clinical checks" within an existing self-report measure. These are brief supplementary questions intended to clarify and confirm initial responses, similar to what occurs in a clinical interview. Clinical checks were developed for the items of the International Grief Questionnaire (IGQ), a self-report measure of ICD-11 prolonged grief disorder (PGD). Data were collected as part of a community survey of mental health in Ukraine. Individual symptom endorsements for the IGQ significantly decreased with the use of clinical checks, and the percentage of the sample that met the ICD-11 diagnostic requirements for PGD fell from 13.6% to 10.2%, representing a 24.8% reduction in cases. The value and potential broader application of clinical checks are discussed.

The refugee experience is typically characterized by exposure to numerous premigration traumatic events and postmigration stress in the resettlement environment. Refugees' experiences can lead to elevated rates of psychopathology, including posttraumatic stress disorder (PTSD) and depression. Emotion regulation is a key mechanism contributing to mental health outcomes among refugees. This study examined the impact of age on the association between emotion regulation and critical social outcomes relevant to refugee resettlement, such as social engagement and functional impairment. Participants were 1,081 Arabic-, Farsi-, Tamil- and English-speaking adult refugees. Premigration trauma exposure, postmigration stressors, PTSD symptoms, depressive symptoms, emotion regulation, social engagement, and functional impairment were measured. A series of hierarchical regression and Poisson regression analyses revealed emotion dysregulation as a significant predictor of functional impairment, β = .36, p < .001, and social engagement, Exp B = 0.99, p = .002. A significant interaction between age and emotion dysregulation was associated with both PTSD, β = .05, p = .048 and depressive symptoms, β = .06, p = .010, suggesting a stronger positive association between emotion dysregulation and both PTSD and depressive symptom severity for older individuals. Postmigration stressor exposure, emotion dysregulation, and older age are important factors that may negatively impact social engagement and functional impairment in the resettlement environment. Additionally, higher levels of trauma exposure may negatively impact social engagement. These findings have implications for public health and social services in the context of resettled refugee communities.

Prior research has identified traumatic experiences and substance use as risk factors for adolescent engagement in sexual risk-taking; however, these studies have relied upon subthreshold or non-dually diagnosed samples. The present study examined differences in sexual risk behaviors between adolescents with a substance use disorder (SUD) and co-occurring posttraumatic stress disorder (PTSD) versus those with an SUD and another co-occurring psychiatric disorder. Participants were 269 adolescents who met the clinical screening criteria for an SUD and at least one psychiatric disorder. Bivariate comparisons and generalized linear models were used to compare sexual risk behaviors in participants with co-occurring PTSD (30.0%) and those with a different psychiatric disorder (70.0%). Participants with co-occurring PTSD were twice as likely to have multiple sex partners during the same period compared to those without PTSD, odds ratio (OR) = 2.35, p = .012. They also reported, on average, over twice the incidence rate of unprotected sexual encounters, incidence rate ratio (IRR) = 2.06, p = .034, and a 51.0% higher incidence of sexual risk behaviors, IRR = 1.51, p = .008, than participants without co-occurring PTSD. The results suggest dually diagnosed adolescents with co-occurring PTSD are more likely to engage in sexual risk behaviors than those with a different co-occurring disorder, placing them at higher risk for adverse health effects, such as sexually transmitted infections and unplanned pregnancies. As such, this population is likely to benefit from targeted trauma-informed sexual health education programs focused on sexual risk reduction.