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Introduction: The annual cost of treatment and lost productivity due to chronic pain is estimated to be $635 billion within the USA. Self-management treatments for chronic pain result in lower health care costs and lower utilization of provider-management treatments, such as hospitalization and medication use. The current study sought to identify and characterize patient factors and health conditions associated with chronic pain treatment utilization to inform ways to improve engagement in self-management pain treatment (e.g., applying heat or ice, exercising, or practicing relaxation). This study predicted (1) greater pain intensity and pain interference would be associated with greater utilization of self-management treatments and (2) this association would be moderated by patient factors (gender and age) and health comorbidities (anxiety, trauma, depression, and sleep disturbance).Materials and Methods: Baseline data from a three-arm clinical trial were collected for 127 Veterans seeking treatment for chronic pain. Veterans were recruited via clinician referral and medical record review at the Veterans Affairs Puget Sound Health Care System, Washington, USA.Results: Self-management treatments were more utilized than provider-management treatments. Pain intensity and pain interference were not uniquely associated with provider-management or self-management treatment utilization after controlling for demographics and mental health status. Sleep disturbance moderated the relationship between pain interference and provider-management treatment utilization. Depression moderated the relationship between pain intensity and provider-management treatment utilization.Conclusions: While study conclusions may not generalize to all Veteran populations, findings suggest that Veterans with chronic pain were more likely to seek provider-management treatments when experiencing high-pain interference and high-sleep disturbance. In addition, Veterans were more likely to seek provider-management treatments when experiencing low-pain intensity and high-depression symptoms. [ABSTRACT FROM AUTHOR]

Objective: Shootings in academic settings are associated with the development of both posttraumatic growth (PTG) and posttraumatic stress (PTS) symptoms (Bardeen, Kumpula, & Orcutt, 2013). Traumatic events can challenge an individual's cognitive framework and contribute to the development of PTS and PTG. Intrusive rumination is thought to increase vulnerability to PTS symptoms, whereas deliberate rumination is likely to be associated with PTG. Literature that serves to distinguish the contextual and intraindividual predictors differentially leading to the development of PTS and PTG symptoms is limited. This cross-sectional study examined the relations between trauma proximity and posttraumatic outcomes as mediated by deliberate and intrusive ruminative responses to a university shooting. We hypothesize that (a) physical and emotional proximity would exert distinct effects on posttraumatic outcomes, (b) the effects of proximity on PTS would be mediated by intrusive rumination, and (c) the effects of proximity on PTG would be mediated by deliberate rumination., Method: Three hundred and eighty-five students, faculty, and staff who were exposed to a university campus shooting completed a series of questionnaires 4 months after the event., Results: Emotional proximity was associated with PTS and PTG, whereas physical proximity was only associated with PTS. Of our four hypothesized mediation relationships, intrusive rumination mediated the relationship between physical proximity and PTS, and deliberate rumination mediated the relationship between emotional proximity and PTG., Conclusions: These results suggest that physical and emotional proximity to a traumatic event uniquely contribute to the development of posttraumatic outcomes and that intrusive rumination promotes maladaptive outcomes, whereas deliberate rumination may promote adaptive outcomes. (PsycINFO Database Record (c) 2020 APA, all rights reserved).