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The present study examines the reasons cited by 103 patients for their electing to undergo total knee arthroplastic surgery and the relationship between these reasons and their post-operative pain and range of motion. Results suggest that individuals who describe different reasons for undergoing surgery vary in their post-operative recovery. Specifically, patients who cite pain as the reason they are undergoing surgery report greater levels of pain during the early post-operative period. In contrast, patients who describe goals of regaining mobility or a specific activity as their reason for undergoing surgery achieve a greater range of motion during early post-operative physical therapy. Individuals who express avoidance goals for undergoing total knee arthroplasty report more severe post-operative pain at 1 and 3 months following surgery compared to patients who express approach goals. Interventions targeted towards patients reporting pre-operative pain or avoidance goals may decrease subsequent post-operative pain and increase mobility. [ABSTRACT FROM AUTHOR]

Adherence to highly active antiretroviral therapy (HAART) must be close to perfect in order to maintain suppression of HIV viral load, and to prevent the development of drug resistant strains of HIV. People living with HIV (PLWH) often report low levels of adherence. One variable that has been linked to poor adherence is perceived discrimination; however, research has generally not considered the possible unique effects of different types of discrimination on adherence. The present pilot study aimed to examine the association of three types of discrimination (due to HIV+ status, race, or sexual orientation) with adherence among 57 PLWH. Logistic regression analyses were conducted to demonstrate the relationships between each type of discrimination and self-reported adherence. Racial discrimination significantly predicted lower adherence levels, whereas sexual orientation- and HIV-related discrimination did not. Results underscore the importance of addressing discrimination issues, specifically racial, when designing interventions to improve adherence to HAART. [ABSTRACT FROM AUTHOR]

Recent research suggests that the presence of posttraumatic stress disorder (PTSD) and depressive symptoms is independently related to abnormal hormone levels, inadequate medication adherence, and faster HIV disease progression. Although PTSD and depression occur comorbidly at high rates, the impact of both disorders on adherence and disease progression has not been examined. The present study examined the impact of PTSD and comorbid depression on CD4 cell counts and medication adherence in 58 male and 11 female (36% African American) HIV-positive individuals recruited from an AIDS service organization. Results revealed that participants high in depressive symptoms had lower CD4 cell counts and were less likely to adhere to their medication regimens than participants high in PTSD symptoms and those high in comorbid symptomatology. The present results suggest that the presence of depressive symptoms may be responsible for the observed impact of PTSD on people living with HIV (PLWH), and that failure to examine comorbid disorders may not adequately address the impact of clinical symptoms on people living with HIV. [ABSTRACT FROM AUTHOR]

Presents an abstract of the article 'Responses of Natural Killer Cell Activity to Acute Laboratory Stressors in Healthy Men at Different Times of Day,' by T. Wang, D.L. Delahanty, A.L. Dougall and A. Baum published in the 1998 issue of 'Health Psychology' journal.

Describes the time course of natural killer cell activity and lymphocyte proliferation in response to two acute stressors in healthy men. Association of the six minute stressor period with increased self report of pain and distress; Proliferation of lymphocyte to pokeweed mitogen; Effect of proliferation of the concanavalin A.

Objective: To examine the levels of patient self-advocacy in a sample of participants with Chiari Malformation (CM) and to explore how they relate to clinical outcomes., Methods: As part of a larger clinical trial addressing chronic pain in patients with CM, 111 participants completed the Patient Self Advocacy Scale (PSAS), the Depression, Anxiety, and Stress Scale (DASS-21), and the Brief Pain Inventory (BPI)., Results: PSAS scores indicated a moderately high level of patient self-advocacy (Mean = 3.86 SD = 0.50). The PSAS was not related to depression, anxiety, stress, pain intensity, or pain interference. There were no differences in PSAS according to surgical status ( t (61.25) = 0.44, p  = 0.66) or use of pain medication ( t (109) = 1.05, p  = .29)., Discussion: Participants in a clinical trial for CM have high levels of pre-existing patient self-advocacy. Research is needed to understand how patient self-advocacy contributes to the management of CM and how it could impact research of individuals with understudied conditions., Clinical Trials Registration: NCT05581472., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

In the present study we report the relationship among MRI-based skull and cervical spine morphometric measures as well as symptom severity (disability-as measured by Oswestry Head and Neck Pain Scale and social isolation-as measured by the UCLA Loneliness scale) on biomarkers of allostatic load using estrogen, interleukin-6, C-reactive protein, and cortisol in a sample of 46 CMI patients. Correlational analyses showed that McRae line length was negatively associated with interleukin-6 and C-reactive protein levels, and Analysis of Variance (ANOVA) showed joint effects of morphometric measures (McRae line length, anterior CSF space) and symptom severity (disability and loneliness) on estrogen and intereukin-6 levels. These results are consistent with allostatic load. That is, when the combination of CSF crowding and self-report symptom (disability and loneliness) severity exceed the capacity of biological resilience factors, then biomarkers such as neuroprotective estrogen levels drop, rather than rise, with increasing symptom severity., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Post-traumatic stress disorder (PTSD) genetics are characterized by lower discoverability than most other psychiatric disorders. The contribution to biological understanding from previous genetic studies has thus been limited. We performed a multi-ancestry meta-analysis of genome-wide association studies across 1,222,882 individuals of European ancestry (137,136 cases) and 58,051 admixed individuals with African and Native American ancestry (13,624 cases). We identified 95 genome-wide significant loci (80 new). Convergent multi-omic approaches identified 43 potential causal genes, broadly classified as neurotransmitter and ion channel synaptic modulators (for example, GRIA1, GRM8 and CACNA1E), developmental, axon guidance and transcription factors (for example, FOXP2, EFNA5 and DCC), synaptic structure and function genes (for example, PCLO, NCAM1 and PDE4B) and endocrine or immune regulators (for example, ESR1, TRAF3 and TANK). Additional top genes influence stress, immune, fear and threat-related processes, previously hypothesized to underlie PTSD neurobiology. These findings strengthen our understanding of neurobiological systems relevant to PTSD pathophysiology, while also opening new areas for investigation., (© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

The purpose of this study was to examine the dynamic relationships between daily PTSD symptom severity (PTSS), cognitive and behavioral avoidance coping, and negative drinking consequences following recent injury. Participants consisted of 36 injury survivors (M age  = 34.0, SD = 10.8; 75.0% male; 69.4% White) who completed thrice daily assessments of PTSS, avoidance coping, and negative drinking consequences for 7 days at 6-weeks post-injury. Although hypothesized relationships were not statistically significant in full models with covariates that included alcohol consumption, the confidence intervals associated with focal predictors provided support for predictions. Follow-up analyses without covariates indicated that on occasions when an injury survivor engaged in more avoidance coping and experienced higher levels of PTSS, negative drinking consequences increased by 9% (b = 0.02, SE = 0.01, p  = .006). This interaction was primarily driven by cognitive avoidance coping (b = 0.03, SE = 0.01, p  = .008). Routine screening of avoidance coping, PTSS, and alcohol consumption in the aftermath of recent injury might assist with identifying survivors at risk for negative drinking consequences. Interventions that address cognitive avoidance coping and drinking among survivors experiencing elevated PTSS may help to prevent the development of this comorbidity.

There is a wealth of research linking adverse childhood experiences (ACEs) with negative outcomes later in life, but less research has focused on the effects of protective childhood experiences (PCEs). PCEs have been shown broadly to promote resilience, but the precise nature of this association is not clear, particularly in studies of at-risk adults. The current investigation explored the association between recollection of early life experiences and in vivo emotional responses in at-risk adults. In 2018, 56 active-duty firefighters reported childhood experiences via a questionnaire. Using a semistructured interview, firefighters then responded to questions about recent emotionally evocative experiences (positive and negative) as a firefighter. Emotion was measured in vivo via sympathetic arousal and recorded facial expressions of emotion. Individuals who reported more PCEs expressed significantly more facial expressions of positive emotion across contexts, sr 2 = .11-.14. Early childhood experiences were not significantly associated with negative facial expressions or changes in sympathetic reactivity, but ACEs were associated with tonic levels of arousal in a negative context, r = -.36. Given the adaptive role of positive emotions in adjustment to adverse events, the current investigation suggests a potential protective association between PCEs and the expression of emotion even within a high-risk context, which could help explain the resilience promoting role of PCEs., (© 2023 International Society for Traumatic Stress Studies.)

Background: It is unclear if protective childhood experiences (PCEs), like emotional support and economic stability, exert influence on adulthood adjustment. Prior research suggests PCEs can promote childhood resilience through increased social connection. In contrast, research has demonstrated potential life-long negative impacts of adverse childhood experiences (ACEs) on psychological health. This study examined the role of PCEs and ACEs in psychological symptoms following potentially traumatic events (PTE) in adults., Methods: Participants (N = 128) were adults admitted to two Level 1 Trauma Centers following violence, motor-vehicle crashes, or other accidents. Participants reported childhood experiences and completed assessments of depression, PTSD, and social support at one, four, and nine months post-PTE., Results: Structural Equation Modeling was used to simultaneously model PCEs and ACEs as predictors of psychological symptoms over time, with potential mediation through social support. PCEs overall did not directly affect psychological symptoms nor indirectly through social support. However, the emotional support component of PCEs had an indirect effect on psychological symptoms at baseline through social support. ACEs predicted greater psychological symptoms at baseline and over time., Conclusion: PCEs consisting of childhood emotional support indirectly promote adjustment in adults after PTEs through initial social support, while ACEs exert direct effects on psychological symptoms.

Background: Social support confers a protective effect against elevated PTSD symptomatology following injury. However, little is known about the mechanisms through which social support conveys this protective mental health effect in injury survivors. Coping self-efficacy is linked to both social support and PTSD symptomatology but has not been examined., Objective: To test coping self-efficacy as a mechanism for the relationship between social support and PTSD symptom severity among injury survivors., Method and Design: Participants consisted of 61 injury survivors (62.3% male, 72.1% White) admitted to a Level-1 Trauma Center. Social support was assessed at 2-weeks post-injury; coping self-efficacy at 6-weeks post-injury; and PTSD symptom severity at 3-months post-injury., Results: A statistically significant indirect effect was found for the social support - coping self-efficacy - PTSD symptomatology pathway, providing evidence of mediation even after controlling for age, sex, race, and education ( B  = -0.51, SE  = 0.18, CI  = -0.92, -0.20)., Conclusions: Social support may exert an effect on PTSD symptom severity post-injury through its connection with coping self-efficacy. Coping self-efficacy represents an important intervention target following injury for those survivors with lower social support who are at risk for elevated PTSD symptom severity levels.

Objective: A significant proportion of military veterans successfully transition out of the military into civilian careers as first responders, such as firefighters. Like military service, being a firefighter is a high-risk profession involving exposure to aversive environments. Thus, it is possible that military experience might serve to buffer or exacerbate risk for negative psychological outcomes in firefighters. However, both occupations are associated with increased risk for psychopathology, such as PTSD, and little research has examined the effect of military service on processes that underlie stress in veterans serving as active-duty firefighters. The current study explores whether military service confers an adaptive advantage or an additional risk., Method: Using a case-control design, we examined differences in fear reactivity through electrodermal activity (EDA) and recording of fearful facial expressions, between 32 firefighters with and 32 firefighters without military veteran status (MVS; all men). Participants completed a semistructured, emotionally evocative interview with multiple contexts eliciting varying levels of emotion., Results: MVS firefighters had relatively elevated EDA across contexts. However, lower baseline levels indicated calmer resting state in MVS firefighters. There was greater incidence of lifetime PTSD in MVS compared with non-MVS firefighters (40.6% vs. 15.6%). Overall, firefighters with past PTSD had less EDA reactivity. Finally, number of military deployments was associated with higher fear expressions throughout the interview., Conclusions: These findings highlight the need to consider interactions between military experience and psychiatric history in future investigations examining risk and resilience in first responders. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Posttraumatic stress disorder (PTSD) is frequently comorbid with substance use disorder (SUD) in individuals seeking treatment for substance use. Further, SUD and PTSD are individually associated with cognitive impairment (CI) and poor treatment outcomes. Despite the frequent use of the Montreal Cognitive Assessment (MoCA) as a screening tool for CI, the validity of the MoCA has not been established in individuals with comorbid SUD-PTSD. We assessed the criterion validity of the MoCA in 128 participants seeking inpatient medically-assisted detoxification using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) as a reference for CI. The correlation between the RBANS and MoCA was weaker in those with SUD-PTSD ( r = .32) relative to SUD alone ( r = .56). Receiver operating characteristic (ROC) curves demonstrated that the MoCA had moderate-to-high ability to discriminate CI in individuals with SUD alone, with an area under the ROC curve of .82 (95% CI .69-.92) and optimal cutoff score of ≤23. However, in individuals with comorbid SUD-PTSD, the ROC analysis was not significant. Results suggest that PTSD, when comorbid with SUD, reduces the criterion-related validity of the MoCA. We recommend exercising caution when classifying CI in individuals with SUD-PTSD using the MoCA and suggest reducing the cutoff score to ≤23 in order to limit the rate of false-positive CI diagnoses in SUD-PTSD populations.

Introduction: Symptoms of depression, anxiety, and stress in pregnant women are generally highest in the first trimester and then decrease throughout pregnancy, reaching their lowest point in the postpartum period. Pregnant women are a high-risk population for mortality and mental health symptoms due to COVID-19. However, the extent to which the chronic stress of the COVID-19 pandemic alters the trajectory of depression, anxiety and stress symptoms in pregnant/postpartum women is unknown., Methods: Women (N=127) who were pregnant or who had given birth less than one month prior were recruited via online advertising during the COVID-19 pandemic. Participants were assessed up to three times during the pregnancy and at 1-month postpartum for depression (Edinburgh Postnatal Depression Scale), anxiety, and stress (Depression, Anxiety, and Stress Scale-21). Random intercepts models examined symptom change over time as well as predictors of elevated postpartum psychopathology., Results: On average, women completed their surveys at 8.5 weeks (first trimester), 21 weeks (second trimester), 32 weeks (third trimester) and 7-weeks postpartum. Women reported mild-moderate levels of depression, anxiety, and stress throughout pregnancy. There was a significant change in symptoms of depression and anxiety over time which was best represented by a quadratic rather than linear trajectory: symptoms increased until week 23-25 and then decreased. Stress levels remained consistently elevated over time. Higher symptom levels at 1-month postpartum were predicted by younger age, lower social support, and worry about going to a healthcare facility. Change in routine due to COVID-19 was not predictive of symptom trajectory from pregnancy to postpartum., Conclusions: During COVID-19, symptoms of depression and anxiety increased from early to mid-pregnancy but then declined slightly while stress levels remained elevated. Observed reductions in symptoms were small. Given the substantial persistent impact of perinatal distress and poor mental health on maternal and fetal health, providers should be aware of heightened levels of these symptoms in pregnant women during large-scale external health stressors such as COVID-19, and should implement screening procedures to identify and appropriately intervene with at-risk women., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Pretrauma internalizing and externalizing behaviors have been found to predict posttraumatic stress disorder (PTSD) symptoms (PTSS) in children following injury. However, child in-hospital self-report of pretrauma symptoms may be impacted by their injury and associated medical care (e.g., sedation/pain medications). Parental report of child pretrauma risk factors may be easier to capture; however, mothers and fathers differ in the extent to which they report, and agree on, internalizing versus externalizing behaviors in their child. The present study examined the differential utility of maternal versus paternal ratings of child preinjury internalizing, externalizing, and prosocial behaviors in predicting child PTSS 3- and 6-months postinjury. Eighty-four children were recruited from an emergency department after emergency medical services transport following injury, along with their parent(s). Dyadic (one parent and a child) analyses revealed that maternal reports of internalizing behaviors were significantly associated with child PTSS 3 months, F (5, 64) = 9.48, p < .001; ß = .44, p = .01, and 6 months, F (5, 48) = 5.57, p < .001; ß = .42, p = .03, postinjury. Paternal reports were not associated with child PTSS at either time point. In a subsample of triads (mother-father-child), mothers' and fathers' reports were only moderately correlated ( r s = .30-.53), and neither maternal nor paternal ratings individually predicted child PTSS when both parents' reports were included in the model. Exploratory analyses revealed that family conflict and maternal initial PTSS moderated the relationship between maternal ratings of internalizing behaviors and child 3-month PTSS. Results suggest that maternal reports of child preinjury internalizing behaviors should be considered as predictors of later child PTSS development. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Background/Objective: Using two different high-risk samples, the present study compared and contrasted two different strategies/questionnaire types for assessing a history of sexual violence: a general trauma screening vs. specialised behaviourally-specific questionnaires. Methods: Sample 1 included 91 men and women seeking detoxification treatment services in a publicly funded, urban clinic who completed a trauma and substance use questionnaire battery during treatment. Sample 2 included 310 women at a rural college who completed a trauma and religious coping questionnaire battery for course credit. All participants completed both types of questionnaires: One general trauma screening questionnaire (i.e. the Life Events Checklist [LEC]) and two behaviourally-specific specialised questionnaires (i.e. the 2007 Sexual Experiences Survey [SES] and the Childhood Trauma Questionnaire [CTQ]). Results: There were large differences in the cases identified by the behaviourally-specific questionnaires (SES and CTQ) compared to the general trauma screening questionnaire (the LEC) in both samples but few differences in the prevalence rates of sexual violence detected by each questionnaire type. In the detoxification sample, the differences were especially notable for men. Follow-up analyses indicated that degree of traumatisation impacted results likely by increasing participant's willingness to endorse face-valid items on the LEC. Conclusions: For men, the behaviourally-specific questionnaires (SES/CTQ) were necessary to identify cases. For those with more severe trauma histories, the LEC was equivalent to the SES/CTQ in identifying a similar number of sexual violence cases. Thus, clinicians and researchers should consider the population when selecting assessments to identify sexual violence history.

Background: Dysmenorrhea (painful menstrual cramps) is one of the most common gynecological complaints in women and girls. Dysmenorrhea may be a condition itself or a result of another medical condition, including endometriosis and chronic pelvic pain. Research examining the relationship between menstrual pain ratings and catastrophizing has produced mixed results., Objective: To review and meta-analyze the relationship between catastrophizing and pain ratings of chronic cyclical pelvic pain., Design: Cross-sectional, longitudinal, and intervention studies that reported the relationship between menstrual/pelvic pain and catastrophizing were included. Study populations had to include healthy menstruating persons or persons with a condition associated with cyclical pelvic pain including primary dysmenorrhea, endometriosis, and/or chronic pelvic pain., Data Sources and Methods: A systematic search of articles published since 2012 on PubMed, PsychInfo, CINHAL, and Medline was conducted in January and rerun in November of 2022. Search terms included cyclical pelvic pain, dysmenorrhea, endometriosis, pelvic pain, and catastrophizing. Data extraction was completed independently by two extractors and cross-checked for errors. A random-effects meta-regression was used to synthesize the data using restricted maximum likelihood., Results: Twenty-five studies examining 4,540 participants were included. A random effects model found a meta-correlation between catastrophizing and pain of r  = .31 (95% confidence interval: .23-.40) p  < .001. Heterogeneity was large and significant ( I 2  = 84.5%, Q (24) = 155.16, p  < .001). Studies that measured general pelvic pain rather than cyclical pelvic pain specifically and those that used multi-item rather than single-item measures of pain had significantly higher correlations. Age and depression did not moderate the relationship between catastrophizing and pain., Conclusion: A systematic review and meta-analysis found that catastrophizing had a small but significant positive association with pain ratings. Patients experiencing cyclical pelvic pain may benefit from interventions targeting the psychological management of pain., Registration: This meta-analysis was registered in PROSPERO on 14 January 2022. Registration number: CRD42022295328.

Rates of, and relationships between, posttraumatic stress disorder (PTSD), depression, anxiety, and posttraumatic growth (PTG) decades after a single-incident trauma remain unclear. During a two-month period surrounding the 50th anniversary of the political protest violence at Kent State University on May 4, 1970, 132 individuals completed measures of PTG, PTSD, depression, anxiety, and sleep difficulties. Participants were, on average, 19 years old (SD = 3.01) on May 4, 1970, and 44% were present at the protests. 17% met cutoff scores consistent with PTG, 6% for PTSD, 8% for anxiety, 11% for depression and 20% for sleep difficulties. PTG was significantly and positively correlated with PTSD ( r  = .32, 95% CI: 0.17-0.44) and anxiety ( r  = .23, 95% CI: 0.08-0.38) but not depression or sleep difficulties after controlling for additional trauma exposure since May 4, 1970. All relationships were best explained by linear rather than curvilinear relationships and were not moderated by proximity to the events of May 4, 1970. Results indicate that clinicians working with survivors of trauma decades later may be able to capitalize on the adaptive functions of PTG to foster positive treatment outcomes., Competing Interests: Conflict of InterestThe authors have no actual or potential conflicts of interest to disclose., (© The Author(s), under exclusive licence to Springer Nature Switzerland AG 2023, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Introduction: Social support is a key protective factor in the psychological adjustment of individuals to traumatic events. However, since March 2020, extant research has revealed evidence of increased loneliness, social isolation, and disconnection, likely due to COVID-19 pandemic-related recommendations that restricted day-to-day contact with others., Methods: In this investigation, we applied a case-control design to test the direct impacts of the pandemic on social support in United States adults recovering from a significant injury caused by PTSD-qualifying, traumatic events (e.g., motor vehicle crashes, violence, etc.). We compared individuals who experienced trauma during the pandemic, the "cases" recruited and evaluated between December 2020 to April 2022, to trauma-exposed "controls," recruited and evaluated pre-pandemic, from August 2018 through March 9, 2020 (prior to changes in public health recommendations in the region). Cohorts were matched on key demographics (age, sex, education, race/ethnicity, income) and injury severity variables. We tested to see if there were differences in reported social support over the first 5 months of adjustment, considering variable operationalizations of social support from social network size to social constraints in disclosure. Next, we tested to see if the protective role of social support in psychological adjustment to trauma was moderated by cohort status to determine if the impacts of the pandemic extended to changes in the process of adjustment ., Results: The results of our analyses suggested that there were no significant cohort differences, meaning that whether prior to or during the pandemic, individuals reported similar levels of social support that were generally protective, and similar levels of psychological symptoms. However, there was some evidence of moderation by cohort status when examining the process of adjustment. Specifically, when examining symptoms of post-traumatic stress over time, individuals adjusting to traumatic events during COVID-19 received less benefit from social support., Discussion: Although negative mental health implications of the pandemic are increasingly evident, it has not been clear how the pandemic impacted normative psychological adjustment processes. These results are one of the first direct tests of the impact of COVID-19 on longitudinal adjustment to trauma and suggest some minimal impacts., Competing Interests: The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Mitchell, Gawlik, Baugher, George, Muakkassa, Mallat, Gunstad, Delahanty and Coifman.)

Posttraumatic stress disorder (PTSD) is a heritable (h 2  = 24-71%) psychiatric illness. Copy number variation (CNV) is a form of rare genetic variation that has been implicated in the etiology of psychiatric disorders, but no large-scale investigation of CNV in PTSD has been performed. We present an association study of CNV burden and PTSD symptoms in a sample of 114,383 participants (13,036 cases and 101,347 controls) of European ancestry. CNVs were called using two calling algorithms and intersected to a consensus set. Quality control was performed to remove strong outlier samples. CNVs were examined for association with PTSD within each cohort using linear or logistic regression analysis adjusted for population structure and CNV quality metrics, then inverse variance weighted meta-analyzed across cohorts. We examined the genome-wide total span of CNVs, enrichment of CNVs within specified gene-sets, and CNVs overlapping individual genes and implicated neurodevelopmental regions. The total distance covered by deletions crossing over known neurodevelopmental CNV regions was significant (beta = 0.029, SE = 0.005, P = 6.3 × 10 -8 ). The genome-wide neurodevelopmental CNV burden identified explains 0.034% of the variation in PTSD symptoms. The 15q11.2 BP1-BP2 microdeletion region was significantly associated with PTSD (beta = 0.0206, SE = 0.0056, P = 0.0002). No individual significant genes interrupted by CNV were identified. 22 gene pathways related to the function of the nervous system and brain were significant in pathway analysis (FDR q < 0.05), but these associations were not significant once NDD regions were removed. A larger sample size, better detection methods, and annotated resources of CNV are needed to explore this relationship further., (© 2022. The Author(s).)

Objective: There are many methodological issues in studying sexual violence, including potential framing effects. Framing effects refer to how researchers communicate the purpose of a study to participants, such as, how the study is advertised or explained. The aim of this study was to investigate if framing effects were associated with differences in participants' self-reported experiences of sexual violence and related correlates., Methods: College students ( N = 782) were recruited to participate in one of four identical studies that differed in the title: "Questionnaires about Alcohol," "Questionnaires about Crime," "Questionnaires about Health," or "Questionnaires about Sexual Assault." Participants chose one of the four studies and completed measures of sexual violence as well as attitudinal and behavioral measures in randomized order., Results: We found significantly more reports of childhood sexual abuse (33.6% vs. 18.5%), rape (33.9% vs. 21.1%), higher frequency of victimization ( M = 11.35 vs. 5.44), and greater acknowledged rape for bisexual people (46.2% vs. 0.0%) in the sexual assault (SA) condition compared to other conditions. There were no differences in sexual violence perpetration or attitudinal or behavioral measures., Conclusion: These results revealed that framing effects, based on the study title, affect outcomes in sexual victimization research. Rape was reported 1.6× more in the "Sexual Assault" condition than in the "Health" condition. It is unclear whether these framing effects reflect self-selection bias or framing related increased reports in the SA condition, suppression of reports in other conditions, or a combination thereof.

Anniversaries of traumatic events are associated with increased symptoms of posttraumatic stress disorder (PTSD), depression, and anxiety, especially in individuals with prior mental health symptoms. However, research has largely focussed on 1-year anniversaries, and it is unclear whether symptom exacerbation persists for more distal, or milestone, anniversaries. Symptoms typically decrease over time after traumatic events, but major anniversaries may be associated with increases in mental health symptoms. During and 3 months after the 50th anniversary of the political protest violence at Kent State University on May 4, 1970, 115 individuals completed measures of PTSD, depression, anxiety, and anniversary-related stress. Participants reported greater stress (t(97) = 4.04 p ≤ .001) during the 50th anniversary compared to 3 months later, but there were no differences in total PTSD (t(114) = .65, p = .52) or depression/anxiety symptoms (all p's > .05). Even in higher-risk individuals (those who previously received mental health services), symptoms did not differ during versus after the anniversary. In general, long-term anniversaries may contribute to transient increases in distress but do not induce major changes in mental health symptoms., (© 2021 John Wiley & Sons Ltd.)

Identifying and promoting resilience factors may offer novel strategies for optimizing the recovery of patients following orthopedic surgery. Prior research has suggested that self-efficacy, positive affect, vigor, and vitality may function as resilience factors in the face of chronic pain. The present study examines these resilience factors in a prospective, cognitive-affective-behavioral pathway to recovery. Patients (n = 110) undergoing unilateral, total knee replacement surgery completed self-report assessments of study variables. Self-efficacy was assessed 2 ½ weeks prior to surgery, positive affect the day after surgery, vitality and vigor one-month following surgery, and post-operative pain at one- and three-months following surgery. Control variables included gender, pain, and depressive symptoms prior to surgery. Path analysis revealed significant coefficients from pre-operative self-efficacy to positive affect during hospitalization (β = .246, p = .017), as well as to vitality (β = .323, p = .001) and vigor (β = .387, p < .001) at one-month following surgery. Both indicators of energy predicted better post-operative recovery (one-month: vitality β = -.254, p = .016; vigor β = -.329, p = .002); three-months: vitality β = -.192, p = .047, vigor β = -.201, p = .044). Findings support a cognitive-affective-behavioral pathway to recovery., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Posttraumatic stress disorder (PTSD) is heritable and a potential consequence of exposure to traumatic stress. Evidence suggests that a quantitative approach to PTSD phenotype measurement and incorporation of lifetime trauma exposure (LTE) information could enhance the discovery power of PTSD genome-wide association studies (GWASs)., Methods: A GWAS on PTSD symptoms was performed in 51 cohorts followed by a fixed-effects meta-analysis (N = 182,199 European ancestry participants). A GWAS of LTE burden was performed in the UK Biobank cohort (N = 132,988). Genetic correlations were evaluated with linkage disequilibrium score regression. Multivariate analysis was performed using Multi-Trait Analysis of GWAS. Functional mapping and annotation of leading loci was performed with FUMA. Replication was evaluated using the Million Veteran Program GWAS of PTSD total symptoms., Results: GWASs of PTSD symptoms and LTE burden identified 5 and 6 independent genome-wide significant loci, respectively. There was a 72% genetic correlation between PTSD and LTE. PTSD and LTE showed largely similar patterns of genetic correlation with other traits, albeit with some distinctions. Adjusting PTSD for LTE reduced PTSD heritability by 31%. Multivariate analysis of PTSD and LTE increased the effective sample size of the PTSD GWAS by 20% and identified 4 additional loci. Four of these 9 PTSD loci were independently replicated in the Million Veteran Program., Conclusions: Through using a quantitative trait measure of PTSD, we identified novel risk loci not previously identified using prior case-control analyses. PTSD and LTE have a high genetic overlap that can be leveraged to increase discovery power through multivariate methods., (Copyright © 2021 Society of Biological Psychiatry. All rights reserved.)

Infusing community-level risk factors into traumatic stress research can broaden intervention targets. The Neighborhood Deprivation Index (NDI) and the Index of Concentration at the Extremes (ICE) are two common community-level risk factors derived from U.S. census data. We provide R scripts facilitating the computation of these risk factors and demonstrate their relationship with PTSD symptomatology in 74 injury survivors assessed at 2-weeks, 6-weeks, and 3-months post-injury. The NDI and the ICE were computed using the Census Data Application Programming Interface, then matched to participants' census tracts using their residential addresses. Results indicated that after controlling for person-level characteristics, both risk factors were associated with PTSD symptom severity at follow up time points (Cohen's f 2 =0.011,.14). This study provides an easy method for computing the NDI and ICE, demonstrates the increased mental health risk that they convey in the aftermath of injury, and highlights their value in intervention efforts., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Chiari malformation type I (CMI) provides an opportunity for examining possible moderators of allostatic load. CMI patients who had (n = 43) and had not (n = 19) undergone decompression surgery completed questionnaires regarding pain, disability, and loneliness, and provided serum samples for IL-6, CRP, estrogen, and free estradiol assays, and saliva samples to assess diurnal cortisol curves. ANOVAs examining surgical status (decompressed versus non-decompressed), loneliness (high vs. low), and disability (high vs. low) as independent variables and biomarker variables as dependent factors found that loneliness was associated with higher levels of cortisol, F(1, 37) = 4.91, p = .04, η 2 P = .11, and lower levels of estrogen, F(1, 36) = 7.29, p = .01, η 2 P = .17, but only in decompressed patients. Results highlight the possible impact of loneliness on biological stress responses and the need to intervene to reduce loneliness in patients with symptomatic CMI., (© 2021. This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply.)

Objective: The present study documented, compared, and contrasted the test-retest reliabilities of the victimization and perpetration forms of a Tactic-first Sexual Experiences Survey (T-SESs) and the Post-Refusal Sexual Persistence Scales (PRSPSs)., Methods: 243 Mechanical Turk workers (116 women, 124 men) completed four questionnaires in a randomized order via anonymous web survey at Time 1 and approximately one week later at Time 2., Results: There were consistent gender differences in test-retest estimates. When assessing a history of victimization in women, both the T-SES and the PRSPS demonstrated evidence of minimal to good reliability (κ > .61, ICC = .86-92) while for men the PRSPS (κ = .64) was more consistent than the T-SES (κ = .59). When assessing a history of perpetration, there were fewer gender differences although post-hoc analyses suggest potential gender differences in assessing substance use facilitated perpetration (κ .48-.83) but were limited by few cases. Continuous scoring approaches were the most reliable, dichotomous scores were mostly reliable, and categorical scores generally did not meet minimal acceptable standards. For the rape victimization acknowledgment items, we found strong evidence of reliability for women (κ = .89, n = 31) and suggestive evidence of reliability for men ( n = 7). There were few differences in reliability between standard and extended versions of the questionnaires., Conclusions: All four questionnaires exhibited good evidence of one-week test-retest reliability when scored continuously. Evidence of reliability was strongest with the populations and constructs most well studied - victimization history among women and perpetration history among men.

Background: The stress-to-disease association has been well-accepted for some time. However, the understanding of how stress exposure contributes to psychological disease progression remains unclear., Objective: To test the real-time impact of variable stress exposure on risk-related clinical phenomena and affective disease progression in a high-risk sample of active-duty firefighters., Methods: Participants completed weekly diaries reporting stressful event exposure, affect, sleep, and risk-related and healthy behaviors over six-months and were evaluated for lifetime and current psychiatric disease using clinical interviews before and after the sampling period., Results: Stress exposure impacted clinical phenomena in differing ways. Major personal events and day-to-day hassles predicted health-impairing shifts in sleep and behavior that were associated with increases in symptoms and psychological distress over the 6-month period. In contrast, highly aversive incidents predicted greater adaptive behaviors that were uniquely predictive of symptom decreases over the six-month period., Conclusion: These findings shed new light on stress-to-disease processes, demonstrating how variable stress exposure influences critical shifts in behavior and sleep, contributing to psychological adjustment of firefighters over time. These data suggest practical ways to monitor risk in high-risk samples (e.g., monitoring sleep latency) and offer avenues for further explication of disease processes in real time.

Background: The prevalence of sexual perpetration in college men is unknown. Prior reviews of sexual violence prevalence rates have produced wide-ranging estimates, likely due to wide variation in measurement strategies., Objectives: This article systematically reviewed research findings (from 2000 to 2017) regarding prevalence rates of sexual perpetration in college men and measurement strategies. Data Sources: PsycINFO and Web of Science databases. Eligibility Criteria: Empirical reports published between 2000 and 2017 that included male participants, available in English, and reported lifetime prevalence findings in Canadian or American college students. Participants: Data from 78 independent samples including 25,524 college men., Results: The average prevalence rate of any sexual perpetration was 29.3% ( SD = 16.8), and the average rate of rape was 6.5% ( SD = 6.3). Studies that used non-Sexual Experiences Survey (SES)-based questionnaires recorded higher prevalence rates (41.5%) than SES-using studies (26.2%). At least 16 different sexual perpetration questionnaires were identified. Modifying standardized questionnaires was extremely common; this was reported in over half of the studies. Studies using modified standardized questionnaires found higher prevalence rates of sexual perpetration than studies using nonmodified standardized questionnaires., Limitations: This report focused exclusively on college men in the United States and Canada., Conclusions and Implications: On average, 29% of college males report engaging in behaviors defined as sexual perpetration; however, there was a strong influence of measurement strategy on reported rates.

Background: Research exploring the longitudinal course of posttraumatic stress disorder (PTSD) symptoms has documented four modal trajectories (low, remitting, high, and delayed), with proportions varying across studies. Heterogeneity could be due to differences in trauma types and patient demographic characteristics., Methods: This analysis pooled data from six longitudinal studies of adult survivors of civilian-related injuries admitted to general hospital emergency departments (EDs) in six countries (pooled N = 3083). Each study included at least three assessments of the clinician-administered PTSD scale in the first post-trauma year. Latent class growth analysis determined the proportion of participants exhibiting various PTSD symptom trajectories within and across the datasets. Multinomial logistic regression analyses examined demographic characteristics, type of event leading to the injury, and trauma history as predictors of trajectories differentiated by their initial severity and course., Results: Five trajectories were found across the datasets: Low (64.5%), Remitting (16.9%), Moderate (6.7%), High (6.5%), and Delayed (5.5%). Female gender, non-white race, prior interpersonal trauma, and assaultive injuries were associated with increased risk for initial PTSD reactions. Female gender and assaultive injuries were associated with risk for membership in the Delayed (v. Low) trajectory, and lower education, prior interpersonal trauma, and assaultive injuries with risk for membership in the High (v. Remitting) trajectory., Conclusions: The results suggest that over 30% of civilian-related injury survivors admitted to EDs experience moderate-to-high levels of PTSD symptoms within the first post-trauma year, with those reporting assaultive violence at increased risk of both immediate and longer-term symptoms.

Objectives: The aim of this project was to test the efficacy of a brief and novel online ambulatory intervention aimed at supporting psychological health and well-being for medical personnel and first responders during the COVID-19 pandemic., Methods: Interested participants, n=28, actively employed as medical personnel, support staff and emergency responders, in the Midwestern USA in May-June of 2020, provided informed consent and were randomised to complete either low-dose or high-dose intervention, one time daily for 1 week via smartphone application. Each daily intervention included expressive writing, adaptive emotion regulation activity and (one vs two) positive emotion-generation activities, lasting 3-6 min a day. Ratings of negative and positive emotion were provided before and after each activity daily. Analyses tested compliance, acceptability, as well as efficacy at increasing positive emotion and decreasing negative emotion with each use and across time., Results: The results indicated a 13% increase in positive emotion, t(25)=2.01, p=0.056; and decrease in negative emotion by 44%, t(25)=-4.00, p=0.001 across both doses. However, there was a clear advantage for individuals in the high-dose condition as daily boosts in positive emotion were significantly greater (an additional 9.4%) B=0.47, p=0.018. Overall, compliance was good. Acceptability ratings were good for those who completed the follow-up assessment., Conclusion: Front-line personnel, including medical staff and emergency responders, are experiencing unprecedented psychological stress during the COVID-19 pandemic. This investigation suggests both feasibility and efficacy for a brief, daily, ambulatory intervention which could provide essential psychological support to individuals at risk in the workplace., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: After injury, many children experience posttraumatic stress symptoms (PTSS) that negatively impact recovery. Acute pain and PTSS share neurobiological pathways, and acute dosage of morphine has been linked to reduced PTSS in naturalistic studies. However, the complex interactions between pain, morphine and other opioid use, and PTSS have yet to be investigated in robust pediatric samples.This prospective, longitudinal study examined relationships between acute pain, opioid medications, and PTSS after pediatric injury., Methods: Ninety-six children aged 8 to 13 years (mean = 10.60, SD = 1.71), hospitalized for unintentional injury, completed assessments at baseline (T1) and 12 weeks (T2) later. Pain ratings and opioid administration data were obtained via chart review., Results: Structural equation modeling revealed that worst pain endorsed during hospitalization was positively associated with concurrent and later PTSS when controlling for evidence-based risk factors (ie, age, sex, prior trauma history, traumatic appraisals of injury event, heart rate). Neither opioid medications overall nor morphine specifically (milligram/kilogram/day) administered during hospitalization mediated the relationship between pain and T2 PTSS., Conclusions: Pain during hospitalization may increase susceptibility for persistent PTSS above and beyond the influence of other empirical risk factors. Findings suggest that pain assessment may be a useful addition to pediatric PTSS screening tools and highlight the need for additional research on pharmacological secondary prevention approaches. Given that inadequate pain control and persistent PTSS each hinder recovery and long-term functioning, better understanding of interactions between acute pain and PTSS after injury is essential for improving screening, prevention, and early intervention efforts.

An amendment to this paper has been published and can be accessed via the original article.

Sexual violence victimization affects approximately 1 in 5 college women and 1 in 6 college men; however, rates of sexual victimization vary widely, in part due to measurement issues. The present study is the first to compare the Sexual Experiences Survey-Short Form Victimization (SES-SFV) to a measure of sexual victimization designed to capture gender differences, the Post-Refusal Sexual Persistence Scale-Victimization (PRSPS-V). Prior research has compared the perpetration versions of these questionnaires and found large discrepancies. College students (N = 673: 367 women, 298 men, 8 gender minority) were surveyed. The SES-SFV identified 260 cases of sexual victimization whereas the PRSPS-V identified 330 cases; this discrepancy was largest for men. While percent agreement between the two measures ranged from 79.9-92.0%, kappa estimates indicated that agreement was in the weak to moderate range. Kappa estimates tended to be poorer for men than women. These results highlight poor precision in the measurement of sexual violence victimization, even when using well-established measures. The PRSPS-V identified more cases and may be less gender biased. We discuss how differences in questionnaire structure, item structure, and operationalization of consent may account for discordance between the SES-SFV and PRSPS-V even when controlling for item content.

Multi-level modeling examined the association between cortisol awakening responses (CAR) and different PTSD symptom clusters in a sample of 158 female participants presenting with intimate partner violence-related PTSD. Results revealed that arousal over the past week and month, respectively ([β = -0.124, z = -2.33, p = .028; β = -.147, z = -2.19, p = .028]) significantly moderated the trajectory of cortisol levels, and emotional numbing symptom severity (over the past week [β = -0.122, z = -2.07, p = .076]) was found to be trending toward significance. In each case higher symptom severity was associated with flatter CAR slopes compared to those with lower symptom severity. Assessing PTSD symptom clusters in relation to cortisol may better inform future interventions compared to studies that assess PTSD globally. Our findings suggest a subtype of PTSD patients displaying higher levels of arousal may be more likely to experience alterations in HPA axis functioning., 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., (Copyright © 2020. Published by Elsevier B.V.)

Background : Studies that identify children after acute trauma and prospectively track risk/protective factors and trauma responses over time are resource-intensive; small sample sizes often limit power and generalizability. The Prospective studies of Acute Child Trauma and Recovery (PACT/R) Data Archive was created to facilitate more robust integrative cross-study data analyses. Objectives : To (a) describe creation of this research resource, including harmonization of key variables; (b) describe key study- and participant-level variables; and (c) examine retention to follow-up across studies. Methods : For the first 30 studies in the Archive, we described study-level (design factors, retention rates) and participant-level (demographic, event, traumatic stress) variables. We used Chi square or ANOVA to examine study- and participant-level variables potentially associated with retention. Results : These 30 prospective studies (N per study = 50 to 568; overall N = 5499) conducted by 15 research teams in 5 countries enrolled children exposed to injury (46%), disaster (24%), violence (13%), traffic accidents (10%), or other acute events. Participants were school-age or adolescent (97%), 60% were male, and approximately half were of minority ethnicity. Using harmonized data from 22 measures, 24% reported significant traumatic stress ≥1 month post-event. Other commonly assessed outcomes included depression (19 studies), internalizing/externalizing symptoms (19), and parent mental health (19). Studies involved 2 to 5 research assessments; 80% of participants were retained for ≥2 assessments. At the study level, greater retention was associated with more planned assessments. At the participant level, adolescents, minority youth, and those of lower socioeconomic status had lower retention rates. Conclusion : This project demonstrates the feasibility and value of bringing together traumatic stress research data and making it available for re-use. As an ongoing research resource, the Archive can promote 'FAIR' data practices and facilitate integrated analyses to advance understanding of child traumatic stress., (© 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

Background: Previous work has indicated that post-traumatic stress disorder (PTSD) symptoms, measured by the Clinician-Administered PTSD Scale (CAPS) within 60 days of trauma exposure, can reliably produce likelihood estimates of chronic PTSD among trauma survivors admitted to acute care centers. Administering the CAPS is burdensome, requires skilled professionals, and relies on symptoms that are not fully expressed upon acute care admission. Predicting chronic PTSD from peritraumatic responses, which are obtainable upon acute care admission, has yielded conflicting results, hence the rationale for a stepwise screening-and-prediction practice. This work explores the ability of peritraumatic responses to produce risk likelihood estimates of early CAPS-based PTSD symptoms indicative of chronic PTSD risk. It specifically evaluates the Peritraumatic Dissociative Experiences Questionnaire (PDEQ) as a risk-likelihood estimator., Methods: We used individual participant data (IPD) from five acute care studies that used both the PDEQ and the CAPS (n = 647). Logistic regression calculated the probability of having CAPS scores ≥ 40 between 30 and 60 days after trauma exposure across the range of initial PDEQ scores, and evaluated the added contribution of age, sex, trauma type, and prior trauma exposure. Brier scores, area under the receiver-operating characteristic curve (AUC), and the mean slope of the calibration line evaluated the accuracy and precision of the predicted probabilities., Results: Twenty percent of the sample had CAPS ≥ 40. PDEQ severity significantly predicted having CAPS ≥ 40 symptoms (p < 0.001). Incremental PDEQ scores produced a reliable estimator of CAPS ≥ 40 likelihood. An individual risk estimation tool incorporating PDEQ and other significant risk indicators is provided., Conclusion: Peritraumatic reactions, measured here by the PDEQ, can reliably quantify the likelihood of acute PTSD symptoms predictive of chronic PTSD and requiring clinical attention. Using them as a screener in a stepwise chronic PTSD prediction strategy may reduce the burden of later CAPS-based assessments. Other peritraumatic metrics may perform similarly and their use requires similar validation., Trial Registration: Jerusalem Trauma Outreach and Prevention Study (J-TOPS): NCT00146900.

In this study, we aimed to examine the relationship between active smoking and environmental tobacco smoke exposure on sleep-quality complaints. In total, 1023 young adult participants completed online surveys. Based on these surveys, participants were classified into three groups according to their level of smoke exposure (low, moderate, high). An analysis of covariance revealed that, after controlling for sex, participants with high and moderate smoke exposure reported more sleep complaints than those with low exposure. Among non-smokers, hierarchical linear regression indicated that environmental tobacco smoke exposure was positively associated with sleep complaints. Improved understanding of modifiable risk factors for young adults' poor sleep quality, such as smoke exposure, could enable lifestyle changes that might lay the foundation for improved health at later life stages., (© 2019 John Wiley & Sons Australia, Ltd.)

Childhood maltreatment is highly prevalent and serves as a risk factor for mental and physical disorders. Self-reported childhood maltreatment appears heritable, but the specific genetic influences on this phenotype are largely unknown. The aims of this study were to (1) identify genetic variation associated with self-reported childhood maltreatment, (2) estimate SNP-based heritability (h 2 snp ), (3) assess predictive value of polygenic risk scores (PRS) for childhood maltreatment, and (4) quantify genetic overlap of childhood maltreatment with mental and physical health-related phenotypes, and condition the top hits from our analyses when such overlap is present. Genome-wide association analysis for childhood maltreatment was undertaken, using a discovery sample from the UK Biobank (UKBB) (n = 124,000) and a replication sample from the Psychiatric Genomics Consortium-posttraumatic stress disorder group (PGC-PTSD) (n = 26,290). h 2 snp for childhood maltreatment and genetic correlations with mental/physical health traits were calculated using linkage disequilibrium score regression. PRS was calculated using PRSice and mtCOJO was used to perform conditional analysis. Two genome-wide significant loci associated with childhood maltreatment (rs142346759, p = 4.35 × 10 -8 , FOXP1; rs10262462, p = 3.24 × 10 -8 , FOXP2) were identified in the discovery dataset but were not replicated in PGC-PTSD. h 2 snp for childhood maltreatment was ~6% and the PRS derived from the UKBB was significantly predictive of childhood maltreatment in PGC-PTSD (r 2  = 0.0025; p = 1.8 × 10 -15 ). The most significant genetic correlation of childhood maltreatment was with depressive symptoms (r g  = 0.70, p = 4.65 × 10 -40 ), although we show evidence that our top hits may be specific to childhood maltreatment. This is the first large-scale genetic study to identify specific variants associated with self-reported childhood maltreatment. Speculatively, FOXP genes might influence externalizing traits and so be relevant to childhood maltreatment. Alternatively, these variants may be associated with a greater likelihood of reporting maltreatment. A clearer understanding of the genetic relationships of childhood maltreatment, including particular abuse subtypes, with a range of phenotypes, may ultimately be useful in in developing targeted treatment and prevention strategies.

The current study examined how psychological factors influence hypothetical behavioral responses to threat (BRTT). College women ( n = 113) with a history of sexual victimization completed a standardized lab-based self-defense scenario. Interpersonal skills, coping style, and assertive and nonassertive BRTT during a prior assault predicted assertive BRTT during the task. The use of nonassertive BRTT during past assaults no longer predicted assertive BRTT during the task when accounting for rape acknowledgment. Findings regarding rape acknowledgment demonstrate the complexity of recovery from sexual assault. Our results highlight interpersonal skills as an intervention target for innovative sexual assault risk reduction interventions.