International Society for Traumatic Stress Studies

Trauma and Public Health

The ISTSS 34th Annual Meeting is the largest gathering of professionals dedicated to trauma treatment, education, research and prevention. There will be several workshops, symposia and expert trainings on trauma and public health. 


Concurrent Session One: Symposium

Thursday, November 8 | 9:45 AM to 11:00 AM

Frontline Experiences on Addressing Human Trafficking: Assessment, Services, and Policy

Chair: Felix, Erika, PhD

Human trafficking is a global crime involving the exploitation of men, women, and children for their labor or for commercial sex through force, fraud, or coercion. Once largely invisible from the public eye, there is now legal, social service, and advocacy efforts targeting eliminating what is in essence, modern-day slavery.  In this symposium, we address efforts to improve the service system supporting survivors.  First, we discuss the efforts of one global humanitarian organization to improve the monitoring of the effects of aftercare services, through the development and validation of an Assessment of Survivor Outcomes tool. Then, we discuss their development and initial data on a Global Aftercare Trauma-Informed Care Manual, that is being used to build the capacity of local law enforcement and social service providers to provide trauma-informed care in several low resource countries. Within the United States, using treatment data from a mental health agency, we identify factors that influence survivors’ initiation of mental health services, and its implication for treatment. Finally, we discuss how to engage in policy advocacy through a case example of one community, and resulting implications for supporting survivors. Across all presentations, lessons learned and ideas for future directions will be discussed.

Assessment of Survivor Outcomes Tool, A Measurement for Restoration of Victims of Violent Crimes

Lee, Michele, PhD
International Justice Mission, Washington, District of Columbia, USA

International Justice Mission (IJM) developed the Assessment of Survivor Outcomes (ASO) tool to measure restoration of survivors who have suffered violent crimes such as commercial sexual exploitation, sexual abuse, forced labor, property grabbing, online sexual abuse of children, and police abuse. The assessment identifies key areas of survivors’ vulnerabilities and strengths, by assessing six domains of care: safety, legal protection, mental wellbeing, economic empowerment and education, social support, and physical wellbeing. IJM conducted a two-part validation study to understand the reliability of the ASO in providing an accurate picture of survivor progress toward restoration. As part of the internal validation process, the study team conducted three mixed method validation exercises in a total of 16 IJM field offices that span nine countries. As part of the external validation, 25 SMEs reviewed and provided feedback on the ASO, and 15 organizations implementing programs across eight countries participated in the study by field testing the ASO tool with their survivors and conducting interviews with survivors. Both the internal and external validation studies determined that the ASO tool is accurate, reliable, and usable for measuring progress of survivors rehabilitating from human trafficking and various forms of violence and exploitation.

Trauma-informed Aftercare: A Training Manual for the Provision of Trauma-informed Service for Survivors of Human Trafficking

Wang, David, PhD LP
Biola University, La Mirada, California, USA

International Justice Mission (IJM), with 17 field offices throughout Africa, Latin America, and South and Southeast Asia, developed the Global Aftercare Trauma-Informed Care Manual to build the capacities of service providers working with survivors of trauma (e.g., law enforcement, residential care staff, etc.…) to provide services in a trauma-informed manner that creates safe spaces for survivors to safely engage in all available services.  There are seven modules included in the training manual, which span topics from foundational knowledge of trauma and PTSD and complex trauma, principles of trauma-informed care and competencies, responses to challenging behavior, secondary and vicarious traumatization, and supporting survivors and survivor voice.  An introduction to the training manual (i.e., its contents, how it has been used, lessons learned), along with a preliminary evaluation of the manual based on initial program evaluation data collected from training workshops will be presented.  Recent developments and refinements to the training manual, inclusive of provisions to culturally adapt the treatment manual (i.e., building towards the notion of culturally-informed trauma-informed care) will also be discussed.

Mental Health Characteristics and Treatment Initiation in Survivors of Human Trafficking

Ghafoori, Bita, PhD
California State University, Long Beach, Long Beach, California, USA

Background: Human trafficking is a critical public health issue, yet little is known about the mental health of survivors of trafficking or their mental health service utilization. The current study investigated whether trauma characteristics or mental health needs influence mental health treatment initiation.  Methods: Participants were 74 treatment seeking adults who had experienced human trafficking. Results: Participants were exposed to multiple traumas (M =2.8), and had high endorsement of PTSD (PCL-5 M = 34.3), and subclinical levels of depression (BSI-18 M = 59.43), somatization (BSI-18 M = 55.79), and global severity index of distress (BSI-18 M = 57.30). Of those individuals who were screened, 78.4% attended a consultation, 56.8% attended an intake, and 40.5% attended the first session of therapy. After controlling for significant covariates, it was found that participants with higher global severity index (GSI) of distress and somatization scores were significantly more likely to attend the initial therapy session (for GSI: OR = 1.05, p < .05; for somatization: OR = 1.05, p < .05).   Discussion: Implications for engaging diverse/under resourced/disenfranchised survivors of human trafficking will be discussed.

Grass-Roots Policy Advocacy to Support Survivors of Human Trafficking

Felix, Erika, PhD
University of California, Santa Barbara, Santa Barbara, California, USA

Human trafficking is a critical, global public health concern that requires multi-faceted, multidisciplinary efforts to address it. Public policy advocacy has the benefit of being a no or low-cost effort in which ordinary individuals can engage to make a difference in human trafficking prevention efforts, service delivery, and outcomes. Through a case example of one community, this talk will describe the process of engagement in public policy advocacy and how that coalesced into a local grass-roots movement to address human trafficking at the local, state, federal, and global level. Some of the specific policies and related advocacy efforts will be discussed, such as the Trafficking Victims Protection Act, and a state policy, Californians Against Sexual Exploitation. A brief description of how to contact your local legislators will be provided, as well as a description of the variety of advocacy efforts in which volunteers engaged. Once passed, there have been some challenges in getting some policies fully implemented.  Lessons learned will be highlighted. Over the past eight years, these efforts helped build the foundation for a human trafficking taskforce and related community collaborative, that is now serving the local community.

Concurrent Session Two: Panel Presentation

Thursday, November 8 | 11:15 AM to 12:30 PM

Effective Advocacy for Social Change: International, Multidimensional and Multidisciplinary

Kudler, Harold, MD1; Danieli, Yael, PhD2; Clark, Roger, Other3; Fetchet, Mary, LCSW4

1USA Department of Veterans Affairs, Washington, District of Columbia, USA
2Director of the Group Project for Holocaust Survivors and their Children, New York, New York, USA
3Rutgers University, Camden, New Jersey, USA
4VOICES of September 11, New Canaan, Connecticut, USA

Coherent advocacy is essential to promoting societal change yet only scant attention has been paid to effective advocacy for survivors of psychological trauma (Danieli, 2001; Gomez & Yassen, 2007). This panel spotlights advocacy informed by research, moral calling, personal experience and legal principles as key to effectuating social, cultural and political change, nationally and internationally. Dr. Danieli will report on collaborative developments of international law instruments and practices on behalf of victims’ rights including protection/support, participation, reparation and rehabilitation. Professor Clark will share experience as a scholar-activist on the United Nations Committee on Crime Prevention and Control, in helping create the International Criminal Court, and in addressing the problem of nuclear weapons in the International Court of Justice. Ms. Fetchet will describe policy initiatives and ethical issues impacting survivors and the families of victims of the attacks of September 11th, 2001 and describe how their “voice” led to sweeping intelligence reforms, new research initiatives and delivery of long-term support services. Discussion among panelists and participants will focus on directions in informed advocacy for policy changes needed to preserve the rights of victims/survivors in the aftermath of acts of mass violence, including terrorism.    

Concurrent Session Three: Panel Presentation

Thursday, November 8 | 3:00 PM to 4:15 PM

Rationale, Barriers, and Benefits of Embedding Trauma-focused Caregiver Training in Public Child Welfare Systems: Exploration and Discussion from Multiple Perspectives

Blaustein, Margaret, PhD1; Kinniburgh, Kristine, LICSW2; Rushovich, Berenice, MSW3; Trower, Dana, MSW4

1Trauma Center at Justice Resource Institute, Brookline, Massachusetts, USA
2Justice Resource Institute, Brookline, Massachusetts, USA
3Child Trends, Inc., Bethesda, Maryland, USA
4Fairfax County Dept of Family Services, Fairfax, Virginia, USA

Foster parents play a pivotal role in addressing the needs, safety, and permanence of youth in the child welfare system. An estimated 436,465 youth were in foster care in FY16 in the U.S., with nearly 200,000 of those placed in non-relative homes (AFCARS 2016). Placement stability, linked both to foster home retention and child placement continuity, has key implications for outcomes. Lack of resources, inadequate training, and unmet behavioral health needs are all cited as primary reasons for disruption, whereas provision of support in the form of case manager contact and ongoing training have clear potential to reduce it (Hartnett et al, 2004). In this panel discussion, goals, barriers, strategies and benefits of trauma-focused training for resource caregivers in child welfare systems will be discussed building off of the participants’ experience in embedding such training in a large urban system (Fairfax, VA). Participating will be a child welfare administrator, a curriculum developer, an independent evaluator from the index project and a foster parent. Each participant will provide a brief overview of the goals, process, and challenges of implementation from their unique perspective. Panelists will then discuss implications for child welfare policy and practice, through group discussion and through response to a series of questions from the facilitator and the audience.

Concurrent Session Four: Workshop Presentation

Thursday, November 8 | 4:30 PM to 5:45 PM

Beyond the Medical Model: A Contextualized Justice and Conflict-informed Trauma Program across Five Continents

Hooker, David, PhD, JD, MDiv, MPH1; Yoder, Carolyn, MA, LPC2; Barge, Elaine, MA3

1University of Notre Dame, Notre Dame, Indiana, USA
2Peace After Trauma, Harrisonburg, Virginia, USA
3Independent Consultant, Harrisonburg , Virginia, USA

Three presenters, a trauma/resilience educator, a peacebuilder/lawyer and a trauma therapist, will introduce participants to an evidence-based justice and conflict-informed trauma program, Strategies for Trauma Awareness and Resilience (STAR), that has been used across five continents to address trauma, interrupt cycles of violence and enhance resilience in individuals, communities, and societies.  

Handouts of the STAR framework and an experiential exercise will be used to demonstrate the core concepts and the synergistic value of going beyond a medical model through integrating concepts and tools from neurobiology with restorative justice and conflict transformation. Case examples of curriculum contextualization during STAR’s 16-year history to meet the needs of diverse populations (post-conflict, historical harms, domestic violence, and terrorism) will be presented along with outcomes. How to use a training program as the basis for a community transformation initiative and challenges of implementing a multi-disciplinary trainer of trainers' program across cultures will be discussed.  Research presented will support the ways this program makes a difference in knowledge, practice, views of “the other,” and, internationally, in the extent to which communities engage in development and peacebuilding programs.   

Concurrent Session Six: Panel Presentation

Friday, November 9 | 11:15 AM to 12:30 PM

Psychedelic Therapy for PTSD in People of Color

Williams, Monnica, PhD1; Wetterneck, Chad, PhD2; Siu, Willie, MD3; Reed, Sara, MS, MFT3; Ching, Terence, MS, PhD Student1; George, Jamilah, MDIv4

1University of Connecticut, Storrs, Connecticut, USA
2Rogers Memorial Hospital, Oconomowoc, Wisconsin, USA
3University of Connecticut Health Center, Farmington, Connecticut, USA
4Yale University, New Haven, Connecticut, USA

There is renewed interest in the therapeutic possibilities of psychedelic-assisted psychotherapy for various mental disorders. The Multidisciplinary Association for Psychedelic Studies (MAPS) sponsors 3,4-methylenedioxymethamphetamine (MDMA) assisted psychotherapy trials to determine the safety and efficacy of MDMA-assisted psychotherapy for PTSD. Phases 1 and 2 trials have not included many people of color (POC). The panelists are all involved in different facets of Phase 3 trials, with an emphasis on the inclusion of POC. They will discuss:

  • Addition of a study site focused on the POC trauma experience
  • Recruiting team members from diverse sociocultural backgrounds
  • Ongoing cultural humility training to enhance recognition and validation of experiences of oppression
  • Revision of informed consent documents for all sites to improve acceptability to POC
  • Revision of setting/music during MDMA sessions for cultural congruence
  • Training for independent rater pool, with ongoing supervision for cultural differences

Several of the panelists also received MDMA in a one-time MDMA-assisted psychotherapy trial (MT-1) as part of the MAPS therapist training program. They will discuss their personal experiences through a culturally-informed lens, and how those experiences shape their belief in the potential of MDMA-assisted psychotherapy for healing POC suffering from trauma.

Concurrent Session Seven: Workshop Presentation

Friday, November 9 | 3:00 PM to 04:15 PM

Racial Justice and Trauma-informed Resilient Communities

Kiser, Laurel, PhD MBA1; Connors, Kathleen, MSW, LCSW1; Trueheart, Kim, BA2; Murray, Brian, Other2

1University of Maryland School of Medicine, Baltimore, Maryland, USA
2Liberty Village Project, Baltimore, Maryland, USA

Experiences of traumatic stress in urban African American communities are highly associated with individual, institutional, and structural racism. Strategies to address the intersectionality of trauma and racism are still emerging. Following the death of Freddie Gray in 2015 in Baltimore City, the Breakthrough Series Collaborative (BSC) change methodology was adapted and tested to bridge knowledge-practice gaps and build community capacity to implement trauma and resilience-based practices within a racial justice framework. Nine community teams participated. This workshop explores the promises and challenges of the BSC methodology to achieve the goals of implementing racially justice, trauma-informed practice, reviews lessons learned, and provides recommendations for future efforts. Workshop participants will review the racial justice and trauma and resilience practice themes used in the BSC through experiential segments similar to how content was presented to BSC participants. Highlights of the objectives include: recognizing life experiences and implicit bias; promoting and supporting racially just organizations; creating safe spaces and mobilizing and accessing trauma resources. Finally, participants will discuss implications for using BSC methodology to support community-based programs to strengthen actions to support racial justice and implement trauma informed services. 

Concurrent Session Nine: Workshop Presentation

Saturday, November 10 | 9:45 AM to 11:00 AM

Implications of Islamophobia: Its Impact beyond the Muslim Community and Key Components of Allyship

Saif, Waheeda, LMHC
Riverside Trauma Center, Needham, Massachusetts, USA

American-Muslims are a community experiencing complex, collective trauma – one that they are often held accountable for. Islamophobia is a concern for Western Muslims, with the FBI reporting a 4% increase in hate crimes in 2017, and attacks against American-Muslims jumping 67%, in one year. This workshop will examine the traumatic impact of Islamophobia on American-Muslims, particularly on the identity development of the youth. Fifty-five percent of Muslim children report bullying, and 27% report being discriminated against by a teacher (CAIR, 2015). Prejudicial surveillance increases negative mental health outcomes, particularly subclinical paranoia and anxiety. Muslim patients often face discrimination in healthcare settings and most professionals are not equipped to treat mental illness arising from Islamophobia (Tai & Periyasamy, 2016). We will examine Islamophobia in the context of U.S. history, noting its influence on other minority communities, such as American Jews. Positive ways in which American-Muslims are changing their narrative will be explored. This workshop will include outcomes of eight presentations that provided Muslim parents guidance on how best to address issues of Islamophobia with their children. Attendees will learn key components of Allyship; identifying ways to ally with disenfranchised groups in clinical and non-clinical settings.

Concurrent Session Ten: Symposium

Saturday, November 10 | 11:15 AM to 12:30 PM

Emerging Mental Health Research Priorities in Humanitarian Contexts

Chair: Ruttenberg, Leontien, MMed MBA;
Discussant: Ventevogel, Peter, MD

It is estimated that 92.8 million people will be affected by humanitarian crisis in 2018 (OCHA). This figure has doubled in the past decade. An unprecedented 65 million people around the world are displaced (UNHCR). The burden on the international community and local governments, both in the “north” and the “south” to respond to this humanitarian crisis, whether natural or manmade, is rapidly increasing. The need for trauma and stress related research providing evidence for scalable, low cost, low intensity interventions to address common mental conditions is greater than ever. Each of our speakers will present with a different perspective on emerging mental health research priorities.

Mental Health Integrated Disaster Preparedness for Flood-and Earthquake Affected Communities in Nepal in Haiti

Welton-Mitchell, Courtney, PhD1; James, Leah, PhD MSW1; James, Alexander, PhD1; Noel, Roger, Assistant2; Khanal, Shree Niwas, BA3

1University of Colorado at Boulder, Boulder, Colorado, USA
2Soulaje Lespri Moun, Port-au-Prince, Haiti, Haiti
3Transcultural Psychosocial Organization, Kathmandu, Nepal, Nepal

Given the frequency of natural hazards in Nepal and Haiti, preparedness is crucial. However, evidence suggests that many people do not engage in risk reduction even when they receive training, have sufficient resources, and have survived prior disasters. Mental health symptoms may influence motivation to engage in preparedness. We developed and tested a hybrid mental health and disaster preparedness intervention in Nepal and Haiti. Objectives of the culturally adapted, 3-day manualized group intervention included: to increase disaster preparedness and social cohesion and reduce mental health symptoms. Three studies were conducted, two randomized controlled trials in flood-affected communities in Nepal and Haiti, and one stepped wedge design in earthquake-affected communities in Nepal - for a total of 1,200 households. Results across the three studies indicate that intervention participation was associated with an increase in disaster preparedness and social cohesion. Mental health effects - decreases in depression and PTSD symptoms - were also found in two of the three studies. This low cost mental health integrated disaster preparedness intervention should be adapted and scaled up for use in other communities prone to natural hazards.

Effectiveness of Psychological First Aid Training for Primary Health Care Workers in Sierra Leone on Retention of Acquired Knowledge about early Psychosocial Responses

Sijbrandij, Marit, PhD1; Horn, Rebecca, PhD2; Ager, Alastair, PhD2; Esliker, Rebecca, PhD3; O'May, Fiona, MSc4; Reiffers, Relinde, MSc5; Ruttenberg, Leontien, Other6; Stam, Kimberly, MSc5; de Jong, Joop, MD, PhD7

1VU University, Amsterdam, Noord-Holland, Netherlands
2Queen Margaret University & University of Edinburgh, Edinburgh, NA, United Kingdom
3University of Makeni, Makeni, NA, Sierra Leone
4Queen Margaret University & University of Edinburgh, Edinburgh, Scotland, United Kingdom
5War Trauma Foundation, Diemen, NA, Netherlands
6War Trauma Foundation, Diemen, North Holland, Netherlands
7Vrije Universiteit, Amsterdam, Amsterdam, Netherlands

PFA is the intervention of choice in the immediate aftermath of trauma and adversity, but controlled evaluations of its effects are lacking. We carried out a cluster randomized trial to evaluate the effectiveness of a one-day PFA training on the retention of PFA knowledge in staff members of Peripheral Health Units (PHUs) in Sierra Leone. Second, we investigated whether PFA training improved professional quality of life, professional attitude and confidence in responding to individuals exposed to acute adverse events.

PHUs in Sierra Leone (N=129) were randomized across 1. PFA (206 participants) and 2. control (202 participants). Retention of knowledge about PFA, professional quality of life, professional attitude and confidence was assessed at baseline, post-PFA and 6 months follow-up.

Linear mixed model analyses showed that the increase in retention score between baseline and 6 months follow-up was larger in the PFA condition than in the control condition (p=.0001). No significant differences were found for professional quality of life, professional attitude and confidence. It is concluded that PFA training administered in post-Ebola Sierra Leone, effectively improves knowledge about adequate psychosocial responses to individual exposed to acute adversities. Implications for effective scaling-up of PFA as well as future steps to evaluate PFA’s effectiveness will be discussed.

Development of an Evidence-based System of Care for Children Affected by Armed Conflict

Jordans, Mark
HealthNet TPO, Kathmandu, Nepal

One in ten children globally lives in an area affected by armed conflict. Armed conflict has both direct and indirect effects on children’s social, emotional, educational outcomes, and impacts can occur at multiple levels of the child’s ecosystem- the individual, family, community, society. The presentation will present research into a multi-sectoral, multi-level system of care for children affected by war that addresses children’s needs across different ecological levels. This system is complemented by mechanisms to ensure access and quality of care. The presentation will includes results from studies to; (a) increase detection of children with severe emotional distress, (b) culturally adapting and pilot-test WHO’s Early Adolescents Skills for Emotions (EASE) treatment for Syrian refugee children with severe emotional distress, and (c) assess EASE facilitators’ competence to deliver psychological treatments.

Longer-term Mental Health, Developmental and Systems Impact of Child-friendly Spaces in Humanitarian Crises

Metzler, Janna, DrPH, MPH, MSSW1; Ager, Alastair, PhD2; Savage, Kevin, MSc3; Hermosilla, Sabrina, Other4; Diaconu, Karin, PhD2

1Columbia University, Mailman School of Public Health, New York, New York, USA
2Queen Margaret University & University of Edinburgh, Edinburgh, NA, United Kingdom
3World Vision Australia/International, Geneva, NA, Switzerland
4New York State Psychiatric Institute/ Columbia University, New York, New York, USA

Child friendly spaces (CFS) are a widely used approach to protect and provide psychosocial support to children in emergencies. However, little evidence documents their outcomes and impacts. Building on prior research, this study examines the longer-term impacts of CFS on children’s mental health, psychosocial well-being, protection and development outcomes. Three longitudinal quasi-experimental studies were conducted amongst Congolese refugee children in Uganda, Syrian refugee children in Jordan, and displaced Nepali children following the 2015 earthquake. Survey methods were complemented by participatory sessions, stakeholder mappings and key informant interviews. Findings confirmed potential for short-term benefits of CFS, but the scale of these varies widely by indicator, setting, programming quality and participant characteristics. Longer-term trajectories varied substantially by setting. General trends in Nepal were towards recovery while in the protracted settings of Uganda and Jordan there was evidence of erosion of well-being over time. In such contexts, short-term impacts of sustaining well-being meet a humanitarian objective of relieving suffering, but there was little evidence of longer-term developmental impacts of CFS attendance.

Concurrent Session Ten: Panel Presentation

Saturday, November 10 | 11:15 AM to 12:30 PM

A Multi-site Initiative to Promote Trauma-informed Treatment and Culture Change in Rural Pennsylvania

Bills, Lyndra, MD1; Geiger, Jennifer, MEd2; Minnich, Christopher, MEd2; Taylor, RaeAnn, PhD3; Kicior, Nicholas, MS, Ed4

1Community Care Behavioral Health, Camp Hill, Pennsylvania, USA
2Behavioral Health Alliance of Rural Pennsylvania, State College, Pennsylvania, USA
3Community Care Behavioral Health, Pittsburgh, Pennsylvania, USA
4Journey Health System, Bradford, Pennsylvania, USA

In this panel, we describe a multi-faceted approach that has been successful in promoting trauma-informed organizational change and the implementation of trauma-informed care (TIC) within a network of provider organizations across Pennsylvania. These strategies include a trauma institute supported by the Behavioral Health Association of Rural PA, that delivers training on specific evidence-based trauma treatments and supervision (e.g. Seeking Safety); a learning collaborative ( with support from a managed care organization, Community Care Behavioral Health, with monitoring of screening and staff-reported confidence in delivery of TIC; and a SAMHSA-funded Systems of Care grant with a goal to spread TIC culture across rural PA. The importance of staff supervision and alternative payment models to support TIC will be discussed. To date, over 1207 staff have been trained and 2935 staff educated in TIC in 1683 distinct training episodes. Screening rates reported by 22 rural providers show improvement over time from 39% to 77% of individuals served. Panel discussion by a provider along with consumer video testimonials will focus on the experience of a TIC system. Panelists will discuss the common goal for trauma-informed transformation of organizational and system culture from varying perspectives.

Concurrent Session Eleven: Symposium

Saturday, November 10 | 2:00 PM to 03:15 PM

Self-medication and Beyond: Towards a More Complete Understanding of Trauma and Alcohol Misuse in Under-represented, Community, and National Samples

Chair: Luciano, Matthew, MS;
Discussant: Mills, Katherine, PhD

Existing literature on trauma and alcohol misuse has largely relied on the self-medication hypothesis to understand the etiology of this complex comorbidity. Proposed by Khantzian (1985), this explanatory model states that individuals suffering from psychological distress use substances to reduce their distress. While foundationally important, trauma professionals must expand upon this model and consider how individual-level factors (e.g. sexual orientation, psychosocial qualities) interact with environmental and societal structures (e.g. access to environmental resources, race) to influence this relationship. This symposium will include four papers examining potential mechanisms to better understand the relationship between trauma and alcohol misuse in under-represented, community, and nationally representative samples. First, Dr. Emily Dworkin will expand on the self-medication hypothesis by examining associations between posttraumatic stress symptoms and drinking motives in a national sample of sexual minority women via a longitudinal daily diary methodology. Second, Dr. Anka Vujanovic will explore racial/ethnic differences in relations between posttraumatic stress disorder (PTSD) and depression with alcohol use disorder (AUD) in a cross-sectional community sample of firefighters. Third, Matthew Luciano will present findings from a national sample of trauma-exposed adult drinkers to examine how behavioral economic concepts (e.g. access to environmental rewards) mediate the relation between PTSD and alcohol consumption. Finally, Dr. Elizabeth Straus will examine a nationally representative sample of U.S. veterans to elucidate differences in protective factors across diagnostic groups (PTSD/AUD, AUD alone, PTSD alone) with the goal of identifying potential mechanisms underlying PTSD-AUD comorbidity. The symposium discussant, Dr. Katherine Mills, will provide additional comments on individual presentations and tie these papers together by discussing broader implications and barriers for intervention, policy, and public health.

Associations between Posttraumatic Stress and Drinking Motives in Sexual Minority Women: A Daily Diary Study

Dworkin, Emily, PhD1; Kaysen, Debra, PhD, ABPP2

1University of Washington School of Medicine, Seattle, Washington, USA
2University of Washington, Seattle, Washington, USA

Sexual minority women (SMW) are at high risk of posttraumatic stress disorder (PTSD) and problem drinking. Although PTSD is thought to be functionally related to drinking, whether PTSD symptoms affect SMW’s drinking motives is unclear. To address this gap, this study examined associations between PTSD symptoms and drinking motives among SMW. Participants completed 2 weeks of daily monitoring annually for up to 4 years. PTSD symptoms were averaged across days (i.e., person-mean PTSD symptoms) and this average was subtracted from daily symptoms (i.e., daily-deviation PTSD symptoms). Analyses tested relationships between PTSD symptoms and drinking motives in 55 trauma-exposed SMW who completed monitoring on 409 days. Both person-mean and daily-deviation PTSD symptoms predicted variation in coping motives, but not other motives. When testing anxiety and depression coping motives separately, person-mean PTSD symptoms were positively associated with anxiety coping motives, and both person-mean and daily-deviation PTSD symptoms were positively associated with depression coping motives. This indicates that SMW with higher typical levels of PTSD symptoms may be at risk of drinking to cope, and days when their symptoms are higher than normal may be times of particular risk. Clinicians could help trauma-exposed SMW create plans to avoid problem drinking on days when symptoms fluctuate. 

Associations between Posttraumatic Stress, Depression, and Alcohol Use in Firefighters: Examining Racial/Ethnic Differences

Vujanovic, Anka, PhD1; Gallagher, Matthew, PhD1; Smith, Lia, BA1; Bartlett, Brooke, MA1; Long, Laura, BA1; Tran, Jana, PhD2

1University of Houston, Houston, Texas, USA
2Houston Fire Department, Houston, Texas, USA

Firefighters represent an at-risk group for alcohol misuse and alcohol use disorder (AUD), depression, and posttraumatic stress disorder (PTSD) symptoms. No studies to date have examined racial/ethnic differences in these psychological disturbances among firefighters. In the present study, it was hypothesized that increased PTSD and depression symptom severity both would be related to increased probable alcohol dependence across three racial/ethnic groups. Participants for the current study included 2,925 firefighters (97.2% male) from a large fire department in the southern United States. Approximately 63.4% (n=1,855) identified as white/Caucasian, 19.7% (n=576) as Hispanic/Latino, and 16.9% (n=494) as black/African-American. Among white firefighters, only PTSD was a significant predictor of probable alcohol dependence (β=0.40, 95% CI[0.23,0.58], p< 0.001). Among Hispanic/Latino firefighters, only PTSD was a significant predictor of probable alcohol dependence (β=0.59,95%CI [0.27,0.91], p< 0.001). For black/African-American firefighters, neither PTSD nor depression was a significant predictor of probable alcohol dependence. Results will be interpreted through a cultural lens in order to inform evidence-based, culturally sensitive intervention and prevention efforts for firefighters.  

Protective Factors Associated with Posttraumatic Stress Disorder, Alcohol Use Disorder, and their Comorbidity in U.S. Veterans: Results from the National Health and Resilience in Veterans Study

Straus, Elizabeth, PhD1; Norman, Sonya, PhD2; Haller, Moira, PhD3; Hamblen, Jessica, PhD4; Southwick, Steven, MD5; Pietrzak, Robert, PhD5

1Veterans Affairs San Diego Healthcare System; Department of Psychiatry, UCSD, san diego, California, USA
2National Center for PTSD, San Diego, California, USA
3VA San Diego Healthcare System, San Diego, California, USA
4VA National Center for PTSD, White River Junction, Vermont, USA
5National Center for PTSD Clinical Neurosciences Division/Yale University Dept. of Psychiatry, West Haven, Connecticut, USA

PTSD and alcohol use disorder (AUD) frequently co-occur and result in greater impairment than either disorder alone. Understanding risk and protective factors for PTSD/AUD may elucidate mechanisms underlying their comorbidity. While several risk factors have been identified, less is known regarding protective factors. Our goal was to identify protective factors associated with lower likelihood of having PTSD/AUD rather than either disorder alone.

Data were analyzed from a nationally representative sample of US veterans (N=3,157) aged 21 and older. 16.4% screened positive for PTSD, 14.8% for AUD, and 2.8% for PTSD/AUD.Chi-square analyses revealed that, compared with veterans with PTSD or AUD alone, veterans with PTSD/AUD were less likely to endorse active coping (PTSD/AUD=6.9%, PTSD=19.0%, AUD=18.2%) and positive reframing (PTSD/AUD=8.1%, PTSD=19.5%, AUD=16.1%),but were more likely to endorse use of emotional support.Veterans with PTSD/AUD scored lower than those with AUD only (but not PTSD only) on factors of protective psychosocial qualities and social connectedness(ps<.001).
These findings suggest that veterans with PTSD/AUD are less likely to use adaptive coping strategies and have fewer protective characteristics, which could contribute to the greater impairment. Developing interventions to augment protective factors may help enhance outcomes in this vulnerable population. 

Posttraumatic Stress Disorder and Alcohol Consumption: Understanding Comorbidity Through the Lens of Behavioral Economics

Luciano, Matthew, MS1; Acuff, Samuel, MS1; Olin, Cecilia, BA2; Zakarian, Rebecca, BA (Hons)1; McDevitt-Murphy, Meghan, PhD1; Murphy, James, PhD1

1The University of Memphis, Memphis, Tennessee, USA
2University of Washington, Seattle, Washington, USA

Limits to the self-medication hypothesis warrant a deeper understanding of the complex relation between posttraumatic stress disorder (PTSD) and hazardous drinking. Behavioral economics is a metatheory that combines operant psychology and microeconomic principles to understand the nature of such relations. For example, PTSD-related avoidance and anhedonia may play a role in limiting non-substance reinforcement, leading to an overvaluation of alcohol. The objective of this study was to test if behavioral economic constructs could explain the relation between PTSD and alcohol consumption. Participants were trauma-exposed adult drinkers recruited nationally through Amazon MTurk (N=110). Four mediation analyses were conducted on the relation between PTSD severity (PCL-5) and alcohol consumption (DDQ). Delayed Reward Discounting (DRD), Consideration of Future Consequences (CFC), Reward Probability, and Access to Environmental Reward served as potential mediators. The PTSD-alcohol consumption relationship was mediated by environmental access to rewards (b = -.002, CI = -.005, .-000) and reward experience (b = -.001, CI = -.008, -.000), but not DRD or CFC. Findings suggest a possible behavioral economic mechanism explaining this relationship and highlight the importance of access to resources in PTSD-alcohol misuse relations. Clinical and public health implications will be discussed.