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Background: Women are more likely to experience multiple overlapping pain conditions (MOPCs) relative to men. Post‐traumatic stress disorder can negatively impact the severity and trajectory of chronic pain and its treatment. Specific associations between gender, post‐traumatic stress disorder (PTSD), and MOPCs require further examination. Methods: A cohort of all Veterans in 2021 who met criteria for one or more of 12 chronic pain types was created using national Veterans Health Administration administrative data. MOPCs were defined as the number of pain types for which each patient met criteria. Multivariable logistic regression models estimated gender differences in frequency for each of the 12 pain subtypes, after controlling for demographics and comorbidities. Negative binomial regression was used to estimate gender differences in the count of MOPCs and to explore moderation effects between gender and PTSD. Results: The cohort included 1,936,859 Veterans with chronic pain in 2021, which included 12.5% women. Among those with chronic pain, women Veterans had higher rates of MOPCs (mean = 2.3) relative to men (mean = 1.9): aIRR = 1.31, 95% CI: 1.30–1.32. PTSD also served as an independent risk factor for MOPCs in adjusted analysis (aIRR = 1.23, 95% CI: 1.23–1.24). The interaction term between gender and PTSD was not significant (p = 0.87). Independent of PTSD, depressive disorders also served as a strong risk factor for MOPCs (aIRR = 1.37, 95% CI: 1.36–1.37). Conclusions: Individuals with MOPCs and PTSD may have complex treatment needs. They may benefit from highly coordinated trauma‐sensitive care and integrated interventions that simultaneously address pain and PTSD. Significance: Women were significantly more likely than men to experience MOPCs. PTSD was also significantly, independently, associated with MOPCs. Patients, particularly women, may benefit from tailored interventions that address both trauma and MOPCs. [ABSTRACT FROM AUTHOR]

Long COVID is associated with many symptoms, including fatigue. As some with long COVID report remission of symptoms over time, previous long COVID has become increasingly prevalent. This cross-sectional study assessed differences in fatigue and somatic symptom burden among individuals with current, previous, and no history of long COVID symptoms. An online survey was conducted with United States adults (N = 2,872), with 2,310 reporting never experiencing long COVID, 183 reporting previously experiencing long COVID, and 379 reporting currently experiencing long COVID. Multivariable linear regression analyses were used to assess the association of long COVID status with fatigue and somatic symptom burden. Participants were an average age of 41.3, with the majority identifying as female (51.7%), White (87.6%), and non-Hispanic or Latino/e (87.6%). Both fatigue and somatic symptoms were significantly higher among those with both current (ps < 0.001; d = 1.24, 1.38 respectively) and previous long COVID (ps < 0.001; d = 0.42, 0.82 respectively) compared to those reporting never having long COVID. These differences remained after accounting for health behaviors (alcohol use, tobacco use, physical activity, sleep). Long COVID, regardless of current presence, may be associated with fatigue and somatic symptom burden. [ABSTRACT FROM AUTHOR]

Acceptance and Commitment Therapy (ACT) targets psychological flexibility and the ability to identify behavioral function in context. Properly measuring these constructs is imperative to understanding whether these processes are mechanisms of change in treatment. The current study examined the factor structure of the Comprehensive Assessment of ACT processes (CompACT) and Tacting of Function scale (TOF) in community-dwelling older adults. Factor structure was examined with CFA. Eighty community-dwelling older adults completed questionnaires prior to an intervention. While the original 23-item, 3-factor structure of the CompACT demonstrated inadequate fit, a modified 15-item, 3-factor structure demonstrated adequate fit. The original 1-factor structure of the TOF demonstrated inadequate fit. A modified 2-factor structure of the TOF fit significantly better than the original 1-factor structure; however, this model also demonstrated inadequate fit. Examining the factor structure of the CompACT and TOF in an older adult sample contributes to the field's understanding of the constructs of psychological flexibility and tacting ability and to the clinical utility of these measures in an understudied sample. These findings provide preliminary support for the use of a short-form version of the CompACT to measure therapeutic processes of change in community-dwelling older adults. [ABSTRACT FROM AUTHOR]

The childbearing years represent a period of high risk for mood and anxiety disorders. Pregnancy complications, especially those leading to antepartum hospitalization, increase the risk of mental health concerns. In this quality improvement project, we describe a newly developed behavioral health service designed to increase inpatient antepartum women's access to mental health care. Of the women seen for behavioral health intervention, 29.5% of the women reported elevated symptoms of depression and 47.7% reported elevated symptoms of anxiety. Results represent a call to action to intervene with hospitalized antepartum women with elevated depressive or anxiety symptoms. [ABSTRACT FROM AUTHOR]

Adverse childhood experiences (ACEs) are early-life psychosocial stressors that are associated with poorer mental health and increased cardiovascular disease (CVD) risk in a dose-dependent manner. We examined the feasibility of an 8-wk combined aerobic and resistance exercise training program to improve systolic (SBP) and diastolic blood pressure (DBP), serum endothelin-1 (ET-1), resilience, hope agency, and hope pathways in young women with ACEs. Forty-two healthy women (21 ± 3 yr) with ≥4 (ACE=; n = 28) or 0 ACEs (ACE-; n = 14) participated in this study. Women with ACEs were randomly assigned to an exercise (ACE + EXT; n = 14) or nonexercise control (ACE + CON; n = 14) group, whereas all ACE+ participants were assigned to a nonexercise control (n = 14) group. Hope agency and DBP did not change in any group (P ≥ 0.43), but hope pathways improved only in ACE + EXT (means ± SE change; +1.6 ± 0.74 au, P = 0.032, Hedges' g = 0.53). ET-1 decreased in ACE + EXT only (-0.31 ± 0.15 pg/mL, P = 0.043, g = 0.46). Although the interactions for resilience and SBP did not reach significance (P = 0.05--0.06), forced post hoc analyses indicated that resilience improved (+4.9 ± 1.9 au, P = 0.012, g = 0.64) and SBP tended to improve (-4.0 ± 2.0 mmHg, P = 0.053, g = 0.51) in ACE = EXT only. There were significant associations between changes in hope pathways and SBP (ρ = -0.43, P = 0.023) and ET-1 (ρ = -0.53, P = 0.005), and between changes in SBP and ET-1 (ρ = 0.49; P = 0.012) in the ACE+ group. In summary, structured exercise training reduces serum ET-1 levels, improves positive psychological coping, and may improve SBP in young women with ACEs. The relationships among the changes in hope pathways, SBP, and ET-1 suggest a cardiovascular psychophysiological relationship in young women with ACEs. NEW & NOTEWORTHY This randomized controlled pilot trial shows, for the first time, that 8 wk of structured, progressive exercise training lowers serum endothelin-1 (ET-1) and improves positive psychological coping in young women with significant early-life psychosocial stress. Furthermore, the observed associations among changes in psychological attributes, ET-1, and systolic blood pressure signify a potential interplay between positive psychology and cardiovascular disease risk among women with adverse childhood experiences. [ABSTRACT FROM AUTHOR]

The literature describing psychological interventions for co-occurring obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) is limited. Acceptance and Commitment Therapy (ACT) is a transdiagnostic intervention that targets functionally avoidant behavior underlying both OCD and PTSD. The current case report describes how an ACT-informed approach to treatment was implemented over 14 sessions to treat co-occurring OCD and PTSD in a 9-months postpartum adult woman. The patient was initially referred to psychotherapy by her psychiatrist and showed high motivation to engage in treatment. This case presentation outlines how the intervention targeted core ACT processes while also incorporating components from both exposure and response prevention (ERP) and cognitive processing therapy (CPT) to address the patient's presenting concerns. Measurements of OCD and PTSD symptom severity, as well as of depressive and anxiety symptoms, over the course of treatment are included. Health-related comorbidities, psychiatric medications, and implications are discussed. [ABSTRACT FROM AUTHOR]

Research suggests that a history of trauma and prenatal posttraumatic stress symptoms (PTSS) are predictive of postpartum depression (PPD). Pregnant women at risk for PPD are often identified through depression symptom measures, while PTSS also may help to identify those at increased risk. Women who do not endorse depressive symptoms, though experience PTSS, may be missed when screening is exclusively based on depressive symptoms. The current study aimed to determine if prenatal PTSS were associated with PPD at 4‐ and 12‐week postpartum in trauma‐exposed women. Pregnant women (N = 230) in their third trimester were assessed for depression and PTSS at pregnancy, 4 and 12 weeks postpartum. Traumatic life events were assessed during pregnancy. Hierarchical regression analyses examined predictors of PPD, including history of depression, number of past traumas, and symptoms from the posttraumatic stress disorder (PTSD) Checklist short‐form (PCL‐6). At 4 and 12 weeks postpartum, history of trauma and depression did not predict depressive symptoms, however, irritability and unwanted intrusive memories of trauma were predictive of increased depressive symptoms. Prenatal irritability and unwanted memories may be predictive of elevated PPD symptoms. Future research should examine whether these symptoms represent increased risk of postpartum depressive symptoms to improve screening, prevention, and treatment efforts. [ABSTRACT FROM AUTHOR]

Purpose: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is associated with anxiety and depressive symptoms. Psychological symptoms are predisposing factors for, as well as symptoms of, ME/CFS. Recovery from ME/CFS is poorly understood and heterogenous, and it is unclear how psychological symptoms may change with recovery. The aim of this study was to examine the associations of depressive and anxious symptoms among individuals with current, previous, and no history of ME/CFS.National Health Interview Survey 2022 data were analyzed to assess ME/CFS status, as well as anxiety and depression burden. Adults (unweighted N = 27,651) in the United States reported sociodemographic and health behavior characteristics, with 453 adults reporting current ME/CFS, while 119 reported previous ME/CFS. Sample weights and variance estimation variables were implemented. Multivariable linear regression models were used to analyze the associations between ME/CFS status and anxiety and depression severity after adjusting for sociodemographic and health behavior variables.Participants were on average 48.1 years of age, and most identified as female (51.3%), white (76.6%), and not Hispanic or Latine (82.8%). Current and previous ME/CFS were associated with anxiety and depressive symptoms compared to individuals with no history of ME/CFS. Clinically significant levels of anxiety and depressive symptoms were substantial for individuals with current (37.6%; 49.0%) and previous (26.5%; 33.4%) ME/CFS compared to individuals with no history of ME/CFS (6.1%; 6.7%).ME/CFS, regardless of current presence, was related to significantly greater anxiety and depressive symptom burden.Methods: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is associated with anxiety and depressive symptoms. Psychological symptoms are predisposing factors for, as well as symptoms of, ME/CFS. Recovery from ME/CFS is poorly understood and heterogenous, and it is unclear how psychological symptoms may change with recovery. The aim of this study was to examine the associations of depressive and anxious symptoms among individuals with current, previous, and no history of ME/CFS.National Health Interview Survey 2022 data were analyzed to assess ME/CFS status, as well as anxiety and depression burden. Adults (unweighted N = 27,651) in the United States reported sociodemographic and health behavior characteristics, with 453 adults reporting current ME/CFS, while 119 reported previous ME/CFS. Sample weights and variance estimation variables were implemented. Multivariable linear regression models were used to analyze the associations between ME/CFS status and anxiety and depression severity after adjusting for sociodemographic and health behavior variables.Participants were on average 48.1 years of age, and most identified as female (51.3%), white (76.6%), and not Hispanic or Latine (82.8%). Current and previous ME/CFS were associated with anxiety and depressive symptoms compared to individuals with no history of ME/CFS. Clinically significant levels of anxiety and depressive symptoms were substantial for individuals with current (37.6%; 49.0%) and previous (26.5%; 33.4%) ME/CFS compared to individuals with no history of ME/CFS (6.1%; 6.7%).ME/CFS, regardless of current presence, was related to significantly greater anxiety and depressive symptom burden.Results: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is associated with anxiety and depressive symptoms. Psychological symptoms are predisposing factors for, as well as symptoms of, ME/CFS. Recovery from ME/CFS is poorly understood and heterogenous, and it is unclear how psychological symptoms may change with recovery. The aim of this study was to examine the associations of depressive and anxious symptoms among individuals with current, previous, and no history of ME/CFS.National Health Interview Survey 2022 data were analyzed to assess ME/CFS status, as well as anxiety and depression burden. Adults (unweighted N = 27,651) in the United States reported sociodemographic and health behavior characteristics, with 453 adults reporting current ME/CFS, while 119 reported previous ME/CFS. Sample weights and variance estimation variables were implemented. Multivariable linear regression models were used to analyze the associations between ME/CFS status and anxiety and depression severity after adjusting for sociodemographic and health behavior variables.Participants were on average 48.1 years of age, and most identified as female (51.3%), white (76.6%), and not Hispanic or Latine (82.8%). Current and previous ME/CFS were associated with anxiety and depressive symptoms compared to individuals with no history of ME/CFS. Clinically significant levels of anxiety and depressive symptoms were substantial for individuals with current (37.6%; 49.0%) and previous (26.5%; 33.4%) ME/CFS compared to individuals with no history of ME/CFS (6.1%; 6.7%).ME/CFS, regardless of current presence, was related to significantly greater anxiety and depressive symptom burden.Conclusion: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is associated with anxiety and depressive symptoms. Psychological symptoms are predisposing factors for, as well as symptoms of, ME/CFS. Recovery from ME/CFS is poorly understood and heterogenous, and it is unclear how psychological symptoms may change with recovery. The aim of this study was to examine the associations of depressive and anxious symptoms among individuals with current, previous, and no history of ME/CFS.National Health Interview Survey 2022 data were analyzed to assess ME/CFS status, as well as anxiety and depression burden. Adults (unweighted N = 27,651) in the United States reported sociodemographic and health behavior characteristics, with 453 adults reporting current ME/CFS, while 119 reported previous ME/CFS. Sample weights and variance estimation variables were implemented. Multivariable linear regression models were used to analyze the associations between ME/CFS status and anxiety and depression severity after adjusting for sociodemographic and health behavior variables.Participants were on average 48.1 years of age, and most identified as female (51.3%), white (76.6%), and not Hispanic or Latine (82.8%). Current and previous ME/CFS were associated with anxiety and depressive symptoms compared to individuals with no history of ME/CFS. Clinically significant levels of anxiety and depressive symptoms were substantial for individuals with current (37.6%; 49.0%) and previous (26.5%; 33.4%) ME/CFS compared to individuals with no history of ME/CFS (6.1%; 6.7%).ME/CFS, regardless of current presence, was related to significantly greater anxiety and depressive symptom burden. [ABSTRACT FROM AUTHOR]

The perinatal period is marked by a higher risk of experiencing depressive, anxiety, and/or trauma-related symptoms, a phenomenon that affects millions of individuals each year. Obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) symptoms commonly co-occur but have rarely been examined together beyond prevalence estimates in the perinatal period. Our study aimed to explore patterns of associations among OCD and PTSD symptoms to elucidate within- and between-person effects and how these effects may change over time. Participants (N = 270) were recruited during pregnancy from an academic medical center affiliated with a midwestern university. PTSD, OCD, and depressive symptoms were assessed at pregnancy, 4, 8, and 12 weeks postpartum. A panel graphical vector autoregression model was used to estimate networks. The temporal network provided information regarding directed predictive effects between symptoms, and hyperarousal, neutralizing, and ordering were the most stable and predictive symptoms across time. The contemporaneous network, which yields undirected partial correlations between symptoms at a given moment, indicated that there were positive associations between intrusions and avoidance, hyperarousal and negative alterations in cognitions and mood, as well as between hyperarousal and dysphoria. This study identified hyperarousal and neutralizing as the PTSD and OCD symptoms with the strongest stability, predictive power, and association with other symptoms. Clinically, this indicates that screening for hyperarousal and neutralizing symptoms may identify individuals who could maximally benefit from treatment in the perinatal period. General Scientific Summary: This study elucidates the posttraumatic stress disorder and obsessive-compulsive disorder symptoms most important to assess during pregnancy and the postpartum period. Network analysis determined that negative alterations in cognitions and mood, obsessing, checking, and avoidance symptoms as the symptoms with the highest relative importance in the between-person network, while hyperarousal, neutralizing, and ordering symptoms were the most stable and predictive symptoms across time. Posttraumatic stress disorder and obsessive-compulsive disorder symptoms are not routinely assessed by health care professionals, yet results suggest identified symptoms warrant closer attention in clinical and obstetric settings. [ABSTRACT FROM AUTHOR]

Background: Many women experience new onset or worsening of existing posttraumatic stress disorder (PTSD) symptoms during pregnancy and the early postpartum period. However, perinatal PTSD symptom profiles and their predictors are not well understood., Methods: Participants (N = 614 community adults) completed self-report measures across three methodologically similar longitudinal studies. Mixture modeling was used to identify latent subgroups of trauma-exposed women with distinct patterns of symptoms at pregnancy, 1-month, and 3-month postpartum., Results: Mixture modeling demonstrated two classes of women with relatively homogenous profiles (i.e., low vs. high symptoms) during pregnancy (n = 237). At 1-month postpartum (n = 391), results suggested a five-class solution: low symptoms, PTSD only, depression with primary appetite loss, depression, and comorbid PTSD and depression. At 3-months postpartum (n = 488), three classes were identified: low symptoms, elevated symptoms, and primary PTSD. Greater degree of exposure to interpersonal trauma and reproductive trauma, younger age, and minoritized racial/ethnic identity were associated with increased risk for elevated symptoms across the perinatal period., Limitations: Only a subset of potential predictors of PTSD symptoms were examined. Replication with a larger and more racially and ethnically diverse sample of pregnant women is needed., Conclusions: Results highlight limitations of current perinatal mental health screening practices, which could overlook women with elevations in symptoms (e.g., intrusions) that are not routinely assessed relative to others (e.g., depressed mood), and identify important risk factors for perinatal PTSD symptoms to inform screening and referral., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Interoception is the detection of signals that arise from within the body. Interoceptive sensitivity has been found to be associated with affect and cognition among younger adults, and examination of these relationships in older adult samples is beginning to emerge. Here, we take an exploratory approach to determine how demographic, affective, and cognitive variables relate to interoceptive sensitivity in neurologically normal older adults, aged 60-91 years old. Ninety-one participants completed a comprehensive neuropsychological battery, self-report questionnaires, and a heartbeat counting task to measure interoceptive sensitivity. Our findings revealed several relationships: 1) interoceptive sensitivity was inversely correlated with measures of positive emotionality: participants with higher interoceptive sensitivity tended to have lower levels of positive affect and trait extraversion; 2) interoceptive sensitivity was found to positively correlate with cognition: participants who performed better on the heartbeat-counting task also tended to perform better on a measure of delayed verbal memory; and 3) when examining the predictors of interoceptive sensitivity in a single hierarchical regression model, higher interoceptive sensitivity was related to: higher time estimation, lower positive affect, lower extraversion, and higher verbal memory. In total, the model accounted for 38% of the variability in interoceptive sensitivity ( R 2  = .38). These results suggest that, among older adults, interoceptive sensitivity is facilitative for aspects of cognition but perhaps disruptive for certain aspects of emotional experience.

Objective: Given the strong association between a history of childhood maltreatment and somatic symptoms, identification of therapeutically modifiable intervention targets is warranted. Alexithymia, or difficulty identifying and describing emotions, may be playing an important role. The present study examined contributions of alexithymia and childhood maltreatment as related to somatic symptoms., Method: Participants ( N = 447) completed measures of childhood maltreatment, alexithymia, and somatic symptoms. Two three-step hierarchical linear regressions were conducted to examine the unique contribution of alexithymia after accounting for demographic characteristics and childhood maltreatment. The first regression utilized total scores, and the second explored five domains of childhood maltreatment, a trauma validity index, and three domains of alexithymia., Results: In the first linear regression, childhood maltreatment and alexithymia were significantly associated with higher somatic symptoms. In the second linear regression, childhood maltreatment and alexithymia both significantly added to the model; however, only emotional abuse was significantly associated with somatic symptoms., Conclusions: In line with previous research, childhood maltreatment and alexithymia are associated with somatic symptoms. Given specific domains of alexithymia were nonsignificant in this relationship, it appears no single aspect of alexithymia is of greater importance. Future research should examine these associations longitudinally, as improving alexithymia may help improve outcomes in individuals with childhood maltreatment history experiencing somatic symptoms. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: Forgiveness has been positively associated with health in those with functional disorders. This cross-sectional study examined the relationships among dimensions of forgiveness and physical and mental health in individuals with and without long COVID., Methods: Adults (N = 4316) in the United States took part in an online survey study detailing long COVID presence, physical and mental health, and trait forgiveness. T-tests were performed to assess differences in types of trait forgiveness between individuals with and without long COVID. Linear regression models assessed the contribution of demographic covariates and forgiveness subscales to the physical and mental health of individuals with and without long COVID., Results: Of 4316 participants, 379 (8.8%) reported current long COVID. Participants were an average age of 43.7, and most identified as female (51.9%), white (87.8%), and non-Hispanic/Latino (86.6%). Individuals with long COVID reported significantly less forgiveness of self (p < 0.001, d = 0.33), forgiveness of others (p = 0.004, d = 0.16), and forgiveness of situations (p < 0.001, d = 0.34) than those without long COVID. Among the long COVID sample, forgiveness of self and situations were positively associated with mental health (p < 0.05), but not physical health (p > 0.05). Forgiveness of others was negatively associated with both physical and mental health (p < 0.05)., Conclusion: Forgiveness may be an important consideration in understanding health among individuals with long COVID, emphasizing the importance of developing a multifaceted understanding of the condition., 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 © 2024 Elsevier Inc. All rights reserved.)

Introduction: Rates of cigarette use remain elevated among those living in rural areas. Depressive symptoms, risky alcohol use, and weight concerns frequently accompany cigarette smoking and may adversely affect quitting. Whether treatment for tobacco use that simultaneously addresses these issues affects cessation outcomes is uncertain., Methods: The study was a multicenter, two-group, randomized controlled trial involving mostly rural veterans who smoke (N = 358) receiving treatment at one of five Veterans Affairs Medical Centers. The study randomly assigned participants to a tailored telephone counseling intervention or referral to their state tobacco quitline. Both groups received guideline-recommended smoking cessation pharmacotherapy, selected using a shared decision-making approach. The primary outcome was self-reported seven-day point prevalence abstinence (PPA) at three and six months. The study used salivary cotinine to verify self-reported quitting at six months., Results: Self-reported PPA was significantly greater in participants assigned to Tailored Counseling at three (OR = 1.66; 95 % CI: 1.07-2.58) but not six (OR = 1.35; 95 % CI: 0.85-2.15) months. Post hoc subgroup analyses examining treatment group differences based on whether participants had a positive screen for elevated depressive symptoms, risky alcohol use, and/or concerns about weight gain indicated that the cessation benefit of Tailored Counseling at three months was limited to those with ≥1 accompanying concern (OR = 2.02, 95 % CI: 1.20-3.42). Biochemical verification suggested low rates of misreporting., Conclusions: A tailored smoking cessation intervention addressing concomitant risk factors enhanced short-term abstinence but did not significantly improve long-term quitting. Extending the duration of treatment may be necessary to sustain treatment effects., Competing Interests: Declaration of competing interest None of the authors has a conflict of interest to disclose related to this work., (Published by Elsevier Inc.)

Functional somatic syndromes (FSS) are associated with functional impairments and distress. FSSs are common among young adults, and psychological flexibility may be a transdiagnostic process appropriate for treatment of FSS in this population. The objective of the current study was to compare physical and mental health in young adults with and without a self-reported FSS and examine which psychological flexibility processes are associated with better physical and mental health in the FSS subset. A total of 447 young adults participated in the current study. Individuals who reported an FSS diagnosis were coded as having a self-reported FSS. Physical and mental health and psychological flexibility were measured via self-report. FSS and non-FSS groups were compared regarding demographic characteristics and on the primary outcomes. Hierarchical regression analyses were conducted to examine the role of the psychological flexibility processes in physical and mental health in the FSS subset. Findings revealed that the FSS group scored significantly lower on measures of physical health and demonstrated less behavioral awareness than the non-FSS group. No differences regarding mental health were found. All three psychological flexibility processes were associated with physical and mental health, accounting for 26-49% of the variance in these outcomes. In conclusion, young adults with FSS experience more physical health difficulties than those without FSS. Psychological flexibility processes were related to better physical and mental health in those with FSS. These findings add to the literature and provide preliminary support for psychological flexibility as a future target for intervention development and implementation aimed at young adults with FSS.

Objective: Long COVID has been associated with psychological symptoms, yet it is unknown if the symptom burden of individuals with current and previous long COVID differ. This pre-registered cross-sectional study assessed stress, anxiety, and depression severity among individuals with no history, previous history, or current long COVID symptoms., Methods: Adults (N = 2872) in the United States participated in an online survey detailing experiences related to the COVID-19 pandemic. Included participants reported ≥1 COVID-19 infection, and self-reported long COVID symptoms (past and present) were assessed. A multivariable linear regression evaluated the association of long COVID status and stress, anxiety, and depression severity. Post-hoc contrasts were performed to probe significant differences among no, previous, and current long COVID symptom groups., Results: Of 2872 participants with history of COVID-19 infection, 2310 reported no history of, 183 reported previous history of, and 379 reported current long COVID symptoms. Participants were an average 41.3 years of age, with most identifying as female (51.7%), White (87.7%), and non-Hispanic or Latino (84.1%). Individuals with current and previous history of long COVID reported greater stress, anxiety, and depression compared to the no history group (all ps < 0.05; current vs. no history Cohen's ds = 0.71-0.93; previous vs. no history ds = 0.30-0.66) after adjusting for demographic and lifestyle factors., Conclusions: Both current and previous long COVID may be associated with psychological symptoms., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Rising rates of mental health problems in undergraduate students is a critical public health issue. There is evidence supporting the efficacy of acceptance and commitment therapy (ACT) in decreasing psychological symptoms in undergraduates, which is thought to be facilitated through increases in psychological flexibility (PF) and decreases in psychological inflexibility (PIF). However, little is known about the effect of ACT on these processes in undergraduates. We conducted a systematic review and three-level meta-analysis examining this effect in 20 studies, which provided 56 effect sizes. A combined sample of 1,750 undergraduates yielded a small-to-medium overall effect ( g = .38, SE = .09, p < .001, 95% CI: [0.20, 0.56]). This effect did not depend on control group type, intervention modality, number of sessions, the questionnaire used, whether PF or PIF was measured, or participant age. However, there was a significant mean effect only in studies with a specific clinical target, but not in those without one. Furthermore, the higher the percentage of female participants, the lower the reported effect size. Results suggested that ACT may increase PF and decrease PIF in undergraduates and highlighted various conceptual and measurement issues. Study protocol and materials were preregistered (https://osf.io/un6ce/)., Competing Interests: Declaration of Conflicts of Interest Declaration of conflicts of interest: none. Given their role as an Editorial Board Member, Emily B.K. Thomas had no involvement in the peer-review of this article and had no access to information regarding its peer-review.

Background: Our aim was to determine rates of postpartum mood and anxiety disorders (PMADs) among U.S. women Veterans and the overlap among PMADs. We further sought to identify PMAD risk factors, including those unique to military service., Methods: A national sample of women Veterans completed a computer-assisted telephone interview (N = 1414). Eligible participants were aged 20-45 and had separated from service within the last 10 years. Self-report measures included demographics, general health, reproductive health, military exposures, sexual assault, childhood trauma, and posttraumatic stress disorder (PTSD). The PMADs of interest were postpartum depression (PPD), postpartum anxiety (PPA) and postpartum PTSD (PPPTSD). This analysis included 1039 women Veterans who had ever been pregnant and who answered questions about PPMDs related to their most recent pregnancy., Results: A third (340/1039, 32.7%) of participants were diagnosed with at least one PMAD and one-fifth (215/1039, 20.7%) with two or more. Risk factors common for developing a PMAD included: a mental health diagnosis prior to pregnancy, a self-report of ever having had a traumatic birth experience, and most recent pregnancy occurring during military service. Additional risk factors were found for PPD and PPPTSD., Conclusion: Women Veterans may be at an increased risk for developing PMADs due to high rates of lifetime sexual assault, mental health disorders, and military-specific factors including giving birth during military service and military combat deployment exposures., (Published by Elsevier Inc.)

Background: Depression is a common, serious complication during the postpartum period. Predictors of postpartum depression characterize who is at-risk for persistent symptoms. This study explored how psychological inflexibility affects depressive symptoms at 4 and 12 weeks postpartum., Methods: Participants receiving prenatal care at a medical center were recruited during the second trimester. Participants (n = 180) completed online assessments and diagnostic interviews during the third trimester (≥ 28 weeks gestation), and at 4-, 8-, and 12-weeks postpartum. Online assessments measured psychological inflexibility (PI) and depressive symptoms, while diagnostic interviews measured lifetime history of depression., Results: Mediation analysis examined pathways between 4-weeks postpartum depression, 8-weeks postpartum PI, and 12-weeks postpartum depression. Depressive symptoms at 4-weeks postpartum predicted PI at 8-weeks postpartum (β = 0.31, SE = 0.06, t (177) = 6.06, p < .001). Depressive symptoms at 4-weeks postpartum (β = 0.42, SE = 0.06, t (176) = 7.12, p < .001) and PI at 8-weeks postpartum (β = 0.32, SE = .08, t (176) = 4.09, p < .001) predicted depressive symptoms at 12-weeks postpartum. Depressive symptoms at 4-weeks, 8-week PI, and lifetime history of depression accounted for 42% of the variance in 12-week depressive symptoms (R 2 = 0.42). The confidence interval of the indirect effect (0.04, 0.18) did not include zero, indicating significant mediation by PI., Conclusions: PI mediated the relation between 4- and 12-weeks postpartum depressive symptoms when controlling for lifetime history of depression. Psychological inflexibility is a transdiagnostic target for future prevention and intervention research during the postpartum period., Competing Interests: Conflicts of Interest: The authors do not have relevant conflicts of interest to disclose related to this work. Given their role as an Editorial Board Member, Emily B.K. Thomas had no involvement in the peer-review of this article and had no access to information regarding its peer-review.

Distress tolerance, or the ability to tolerate physically and emotionally aversive experiences, is a target of psychological intervention in contextual behavioral science. It has been conceptualized as a self-reported ability, as well as a behavioral tendency, and operationalized with a wide variability of questionnaires and behavioral tasks. The current study aimed to investigate whether behavioral tasks and self-report assessments of distress tolerance measure the same underlying dimension, two correlated dimensions, or whether method factors accounted for covariation above and beyond a general content dimension. A university student sample ( N = 288) completed behavioral tasks associated with distress tolerance and self-report distress tolerance measures. Confirmatory factor analysis indicated that behavioral and self-report assessments of distress tolerance do not comprise a single dimension of distress tolerance, or two correlated dimensions of self-report or behavioral distress tolerance. Results also failed to support a bifactor conceptualization with a general distress tolerance dimension and domain-specific method dimensions for behavioral and self-report assessments. Findings suggest that more precision and attention to contextual factors are required in the operationalization and conceptualization of distress tolerance., Competing Interests: Declaration of Conflicts of Interest Declaration of conflicts of interest: none. Given their role as an Editorial Board Member, Emily B.K. Thomas had no involvement in the peer-review of this article and had no access to information regarding its peer-review.

Background: Acceptance and Commitment Therapy (ACT) has been shown to be effective in treating internalizing symptoms. Understanding which ACT processes are most closely linked to certain symptoms may help develop targeted treatments. Network analysis an approach to gain insight into the interconnection between processes and the downstream benefits of targeting a particular process. However, limited work to date has explored networks involving ACT processes specifically., Methods: Undergraduate students (N = 447; 76.5 % female; 89.5 % White/Non-Hispanic) completed online questionnaires. The ACT processes assessed included experiential avoidance (AAQ-II), openness, awareness, and engagement (CompACT), and tacting ability (TOF), and internalizing symptoms/well-being (IDAS-II). Zero-order and partial correlation networks were examined as well as resulting communities., Results: In the association network, dysphoria and experiential avoidance, and suicidality (in the concentration network only) were central nodes. In community analyses, experiential avoidance had the strongest influence in the association network, whereas well-being had the strongest influence in the concentration network. Auto-detected communities were also evaluated., Limitations: The present study was cross-sectional and included a largely White, female, undergraduate sample. This limits generalizability to more diverse, clinical, or general community populations. Potential concerns about data are also noted including low reliability on the TOF and two skewed domains on the IDAS-II which may impact stability of centrality metrics., Conclusions: Well-being, dysphoria, and suicidality may be important process-based treatment targets. Further work is needed with diverse samples and using longitudinal designs to examine within person change of the associations between ACT processes and internalizing symptoms., Competing Interests: Conflict of Interest The authors declare no conflicts of interest., (Copyright © 2022. Published by Elsevier B.V.)

Purpose: Chronic pelvic pain (CPP) is a relatively common health problem, impacting around 25 million women globally. This study details the development of a multidisciplinary women's CPP clinic at a major U.S. academic medical center, and examines associations between mood, pain symptoms, and trauma history. Materials and Methods: Data were collected from 96 subjects, including self-report measures (Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Brief Trauma Questionnaire), pain intensity ratings, psychiatric diagnoses, and relevant medical history. Results: Most subjects reported at least one traumatic experience. Nearly half of subjects met criteria for an anxiety disorder and/or a depressive disorder. Most subjects were diagnosed with pelvic floor dysfunction, and more than half were referred to physical therapy. Women with abdominal/pelvic surgery history reported more traumatic experiences than women without surgical history. Women with a history of sexual abuse reported trying more medications and seeking care from a greater number of providers. Many reported pain duration of >2 years. Conclusions: Study findings related to mental health and trauma support a multidisciplinary CPP approach that includes a clinical health psychology component. Future research may investigate the therapeutic processes that apply to this population to identify targeted efficacious interventions.

Objective: Fatigue is a common, debilitating symptom experienced by individuals with chronic disease. Avoidance, or the act of evading unwanted experiences, is associated with fatigue across chronic disease samples. The current study sought to determine the strength of association between fatigue severity and avoidance in individuals with chronic disease., Methods: PubMed, PsycINFO, CINAHL, and ProQuest Dissertations and Theses databases were searched. Eligible studies measured fatigue and avoidance in chronic disease samples. Sixty-six studies were included. Data analyses were conducted in Rstudio. A random effects model was employed, and a weighted mean effect size was computed for fatigue severity and avoidance. Mixed-effects meta-regression analyses were conducted to examine moderating variables, including patient, clinical, and measurement characteristics. Publication bias was examined using funnel plot, trim-and-fill, and p-curve., Results: The meta-analysis comprised of 71 unique patient samples from 66 studies. The total number of included participants was 13,024. A small, positive association was found between fatigue severity and avoidance, r(71) = 0.22, p < .001, 95% CI [0.18-0.27], SE = 0.02. There was also significant heterogeneity, Q(70) = 349.96, p < .001. Moderator analyses examining age, sex, illness duration, avoidance type, and disease sample were all non-significant. Regarding publication bias, trim-and-fill resulted in a modified weighted mean effect size (r(83) = 0.18, p < .001) and a p-curve analysis supported the evidential value of the current analysis., Conclusion: Findings support that among individuals with chronic disease, fatigue severity and avoidance are positively associated, which has implications for behavioral interventions in this population., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Introduction: There are limited reports on the mental health toll associated with the fear of spreading coronavirus disease 2019 (COVID-19) and the associated stay-at-home orders. The goal of the present study was to characterize the self-reported stress of participants from the Kansas City Metropolitan Area (KCMA) and to examine the relation between potential for asymptomatic spread and perceived stress., Methods: This prospective convenience sample study enrolled 461 participants from May 4 to May 22, 2020. Participants were consented and surveyed prior to free SARS-CoV-2 testing. Measures employed included the Perceived Stress Scale-10 and a comprehensive COVID-19 questionnaire. During the study period, testing resources were limited. In the community, only symptomatic individuals or close contacts of known positives could be tested. Our program aimed to reach those who were unable to access testing resources due to their asymptomatic status or other barriers to care., Results: Worry about asymptomatic spread was associated significantly with greater perceived stress (p < 0.001). Higher stress was reported among women (p < 0.001), Hispanic/Latinx (p = 0.001), non-Black/ African American individuals (p < 0.001), and those reporting the presence of COVID-19 symptoms (p = 0.001)., Conclusions: The COVID-19 pandemic has caused significant economic, social, and health disruptions around the world. Distress is significantly related to concern over unintentionally contributing to the spread of SARS-CoV-2 through asymptomatic transmission. In addition to examining outcomes like distress, future research should characterize the modifiable psychotherapeutic processes that might be targeted through intervention among those experiencing distress., (© 2021 The University of Kansas Medical Center.)