This study examined the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) Cognitive Proficiency Index (CPI) in relation to other WAIS-IV indices, overall test battery mean (OTBM), and impairment (IMP) in an outpatient rehabilitation setting. Participants (N ¼ 329) were 35% female and 88% Caucasian with average age and education of 42.9 (SD ¼ 13.5) and 13.6 (SD ¼ 2.4) years, respectively. Participants were grouped by diagnosis and validity: traumatic brain injury (TBI; n ¼ 176; 39% mild), cerebrovascular accident (CVA; n ¼ 52), other neurologic and psychiatric conditions (OTH; n ¼ 49), and questionable performance validity (QPV; n ¼ 52). OTBM was calculated from non-WAIS-IV tests; IMP was dichotomously defined as four or more non-WAIS-IV scores below cutoff (35 T). Significant group differences were observed on CPI, WAIS-IV indices, OTBM, and IMP. CPI significantly contributed (b ¼ .51) to a linear regression model predicting OTBM (R 2 ¼ .63) with education and GAI as covariates. A logistic regression model with IMP as the outcome and education, GAI, and CPI as predictors correctly classified 80% of cases with area under the curve of .86. A previously identified cutoff (CPI < 84) correctly classified 65-78% of clinical groups categorized by IMP. A novel cutoff (CPI 80) differentiated clinical participants with history of mild TBI from the QPV group with sensitivity of 44.2% and specificity of 89.7%. CPI showed incremental validity in predicting OTBM and IMP and warrants further study as a useful clinical addition to other WAIS-IV indices.

The goal of the curriculum is to increase the knowledge, skills, and attitudes related to psychologists working withinIPC; as such, the study sought to assess the educational outcomes of this course. Specifically, the study intended to examine whether exposure to the curriculum would result in significant changes, and significant differences, in students' interest levels and attitudes, as well as, actual and perceived competency levels in IPC. Overall, we aimed to discern whether those who completed the course (1) attained competency in skills necessary to work as a psychologist in integrated primary care, (2) to determine if the course resulted in heightened interest in the field of Integrated Primary Care Psychology, (3) to provide preliminary feedback to the committee regarding potential modifications or enhancements to the course and data collection instruments, and to (4) justify whether the course should be a standard component of a clinical psychology graduate program curriculum. Methods: Participants included doctoral students. The experimental group consisted of students enrolled in the Introduction to IPC course (n=14). These individuals were fourth-year, third-year, and second-year cohort students. The control group (n=18) was comprised of students of similar training within the same program, who were not enrolled in the course. Results: Analyses were run assessing subjective student interest and competency, as well as, group performance on objective module quizzes. Exposure to the curriculum yielded increased student interest levels and increased subjective and objective competency attainment. Further analyses revealed students enrolled in the course reported significant increases in overall interest rates after course completion compared to controls.

This study examined the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) Cognitive Proficiency Index (CPI) in relation to other WAIS-IV indices, overall test battery mean (OTBM), and impairment (IMP) in an outpatient rehabilitation setting. Participants (N ¼ 329) were 35% female and 88% Caucasian with average age and education of 42.9 (SD ¼ 13.5) and 13.6 (SD ¼ 2.4) years, respectively. Participants were grouped by diagnosis and validity: traumatic brain injury (TBI; n ¼ 176; 39% mild), cerebrovascular accident (CVA; n ¼ 52), other neurologic and psychiatric conditions (OTH; n ¼ 49), and questionable performance validity (QPV; n ¼ 52). OTBM was calculated from non-WAIS-IV tests; IMP was dichotomously defined as four or more non-WAIS-IV scores below cutoff (35 T). Significant group differences were observed on CPI, WAIS-IV indices, OTBM, and IMP. CPI significantly contributed (b ¼ .51) to a linear regression model predicting OTBM (R 2 ¼ .63) with education and GAI as covariates. A logistic regression model with IMP as the outcome and education, GAI, and CPI as predictors correctly classified 80% of cases with area under the curve of .86. A previously identified cutoff (CPI < 84) correctly classified 65-78% of clinical groups categorized by IMP. A novel cutoff (CPI 80) differentiated clinical participants with history of mild TBI from the QPV group with sensitivity of 44.2% and specificity of 89.7%. CPI showed incremental validity in predicting OTBM and IMP and warrants further study as a useful clinical addition to other WAIS-IV indices.

The goal of the curriculum is to increase the knowledge, skills, and attitudes related to psychologists working withinIPC; as such, the study sought to assess the educational outcomes of this course. Specifically, the study intended to examine whether exposure to the curriculum would result in significant changes, and significant differences, in students' interest levels and attitudes, as well as, actual and perceived competency levels in IPC. Overall, we aimed to discern whether those who completed the course (1) attained competency in skills necessary to work as a psychologist in integrated primary care, (2) to determine if the course resulted in heightened interest in the field of Integrated Primary Care Psychology, (3) to provide preliminary feedback to the committee regarding potential modifications or enhancements to the course and data collection instruments, and to (4) justify whether the course should be a standard component of a clinical psychology graduate program curriculum. Methods: Participants included doctoral students. The experimental group consisted of students enrolled in the Introduction to IPC course (n=14). These individuals were fourth-year, third-year, and second-year cohort students. The control group (n=18) was comprised of students of similar training within the same program, who were not enrolled in the course. Results: Analyses were run assessing subjective student interest and competency, as well as, group performance on objective module quizzes. Exposure to the curriculum yielded increased student interest levels and increased subjective and objective competency attainment. Further analyses revealed students enrolled in the course reported significant increases in overall interest rates after course completion compared to controls.

Background: African Americans experience more severe and chronic posttraumatic stress disorder (PTSD) symptoms compared to other racial groups, and thus it is important to examine factors that are relevant for the aetiology of PTSD in this population. Although racial discrimination has been implicated as an exacerbating factor in the development and maintenance of PTSD, relatively less is known about mechanisms through which this process may occur. Objective: The purpose of this study was to examine one such mechanism, emotion dysregulation, in two independent samples of African American adults. Method: Trauma-exposed participants were recruited in a large, urban community hospital setting (initial sample n = 1,841; replication sample n = 294). In the initial sample, participants completed a unidimensional measure of emotion dysregulation and self-reported PTSD symptoms based on the DSM-IV. In the replication sample, participants completed a multidimensional measure of emotion dysregulation and a diagnostic interview of PTSD symptoms based on the DSM-5. Mediation analyses were used to test our hypotheses. Results: Across both samples, results indicated that racial discrimination was indirectly associated with PTSD symptoms through emotion dysregulation (even when trauma load was added as a covariate). Conclusions: Taken together, these results provide strong evidence that the association between racial discrimination and PTSD symptoms may be partially explained by the association between racial discrimination and worse emotion dysregulation. These findings elucidate the impact of racist incidents on mental health and identify modifiable emotion regulatory processes that can be intervened upon to enhance the psychological and social wellbeing of African Americans. Discriminación racial y estrés postraumático: examinando la desregulación emocional como mediador en una muestra de la comunidad afroamericana Antecedentes: Los afroamericanos experimentan síntomas de trastorno de estrés postraumático (TEPT) en forma más severa y crónica en comparación con otros grupos raciales y, por lo tanto, es importante examinar los factores que son relevantes para la etiología del TEPT en esta población. Aunque la discriminación racial ha sido implicada como un factor agravante en el desarrollo y mantenimiento del TEPT, se sabe relativamente poco acerca de los mecanismos por los cuales este proceso puede ocurrir. Objetivo: El propósito de este estudio fue examinar uno de tales mecanismos, la desregulación emocional, en dos muestras independientes de adultos afroamericanos. Método: Los participantes expuestos a trauma fueron reclutados en un gran hospital comunitario urbano (Muestra 1 n= 1.841; Muestra 2 n= 294).Todos los participantes completaron una medida de discriminación racial, pero para la muestra 1, los participantes completaron una medida unidimensional de desregulación emocional y síntomas de TEPT auto-informados y para la Muestra 2, los participantes completaron una medida multidimensional de desregulación emocional y una entrevista diagnostica de síntomas de TEPT. Para probar nuestra hipótesis se utilizaron análisis de mediación. Resultados: En ambas muestras, los resultados indicaron que la discriminación racial estuvo asociada indirectamente con síntomas de TEPT a través de la desregulación emocional (incluso cuando la carga del trauma se agregó como una covariable). Conclusiones: En conjunto, estos resultados proveen una fuerte evidencia que la asociación entre discriminación racial y síntomas de TEPT puede explicarse en parte por la asociación entre discriminación racial y una peor desregulación emocional. Estos hallazgos dilucidan el impacto de los incidentes racistas en la salud mental e identifican procesos reguladores de emociones modificables que pueden intervenirse para mejorar el bienestar psicológico y social de los afroamericanos.

Objective: This study was undertaken to increase understanding of environmental risk factors for PTSD and MDD within an urban, impoverished, population. Method: This study examined the demographic characteristics, patterns of trauma exposure, prevalence of PTSD and MDD, and predictors of post-traumatic stress and depressive symptomatology using a verbally-presented survey and structured clinical interviews administered to low-income, primarily African-American (>93%), women and men seeking care in the primary care and obstetrics-gynecology clinics of an urban public hospital. Results: 87.8% (N=1256) of the sample reported some form of significant trauma in their lifetime. Accidents were the most common form of trauma exposure followed by interpersonal violence and sexual assault. Childhood level of trauma and adult level of trauma separately, and in combination, predicted level of adult PTSD and depressive symptomatology. The lifetime prevalence of PTSD was 46.2% and the lifetime prevalence of MDD was 36.7%.

Food addiction (FA) describes a group of disordered eating behaviors. Childhood trauma has been associated with adult FA and trauma has known effects on the endocrine system, but it is unclear whether FA is associated with insulin resistance. We hypothesized that severity of childhood trauma will be associated with FA and higher insulin resistance (HOMA-IR) in a sample of obese women with type 2 diabetes mellitus (T2DM), and that FA will mediate the association between childhood trauma and HOMA-IR. Women with a diagnosis of T2DM (N=73; M BMI =35.86, SD BMI =7.72; M age =50.59, SD age =9.72) were recruited from a diabetes clinic at a county hospital. Participants completed the Childhood Trauma Questionnaire and the Yale Food Addiction Scale. Fasting blood samples were obtained from 64 participants to assess plasma hemoglobin A1c (HbA1c), insulin and glucose (used to calculate HOMA-IR); Oral Glucose Tolerance Test (OGTT) was performed to measure change in glucose and insulin secretion. 48% of the sample met diagnostic criteria for FA. Women with FA reported significantly higher HOMA-IR (F=25.692, p<0.001, df=1,62), HbA1c (F=4.358, p=0.041, df=1,62), and OGGT glucose (F=5.539, p=0.022, df=1,62) as well as severity of childhood trauma (F=10.453, p=0.002, df=1,71). In a hierarchical linear regression controlling for BMI, income level, and T2DM treatment, the severity of childhood trauma did not contribute to the prediction of HOMA-IR (β=−0.011, p=0.942) whereas FA did (β=0.422, p=0.007). In a bootstrapped mediation analysis, the association between childhood trauma and HOMA-IR was mediated by FA severity (b=0.596, p=0.020). Understanding

Available online xxxx Objective: C-reactive protein (CRP), a marker of systemic inflammation, has been associated with psychiatric disorders including major depressive disorder (MDD) and post-traumatic stress disorder (PTSD). Some research suggests that exposure to trauma can trigger increased activity in the inflammatory system. Dissociation is associated with chronic trauma exposure and may be an important factor in understanding the risk for psychiatric outcomes associated with inflammation. The main objective of the current study was to understand how CRP was related to trauma, dissociation, PTSD and MDD in a sample of 55 traumatized African American women with type 2 diabetes mellitus recruited from an urban hospital. Method: High sensitivity CRP (hsCRP) was assayed through blood samples; psychiatric disorders were assessed with structured clinical interviews, dissociation was assessed with the Multiscale Dissociation Inventory, and exposure to trauma in childhood and adulthood was assessed with the Childhood Trauma Questionnaire and the Traumatic Events Inventory, respectively. Results: Correlational results showed a significant association between higher concentrations of hsCRP and child abuse (p b 0.05), overall dissociation severity (p b 0.001), and PTSD symptoms (p b 0.01). ANOVA results showed significantly higher levels of hsCRP in those with current MDD, current PTSD, and remitted PTSD. A hierarchical linear regression model demonstrated a significant association between dissociation symptoms and greater hsCRP levels independent of childhood abuse, PTSD, and MDD (R 2 Δ = 0.11, p = 0.001) and independent of emotion dysregulation (p b 0.05). Conclusion: These findings suggest that dissociation symptoms among those with a history of trauma may be particularly associated with higher levels of inflammation.

Supplemental material, sj-pdf-1-cpx-10.1177_21677026211000723 for Characterizing Typologies of Polytraumatization: A Replication and Extension Study Examining Internalizing and Externalizing Psychopathology in an Urban Population by Yara Mekawi, Eva Kuzyk, H. Drew Dixon, Brooke McKenna, Luisa Camacho, Ana Martinez de Andino, Jennifer Stevens, Vasiliki Michopolous and Abigail Powers in Clinical Psychological Science

Background: Individuals with posttraumatic stress disorder (PTSD) are more likely to present with metabolic diseases such as type-2 diabetes mellitus (T2DM), and cardiovascular dysfunction has been implicated in this link. These diseases disproportionately affect women and individuals exposed to chronic environmental stressors (e.g., community violence, poverty). We examined associations among PTSD, cardiovascular indices, and metabolic function in highly trauma-exposed Black women with T2DM. Methods: Participants (N = 80) were recruited for a follow-up study of stress and T2DM as part of the Grady Trauma Project. PTSD symptoms were assessed with the Clinician Administered PTSD Scale (CAPS-IV). Cardiovascular indices included heart rate (HR), blood pressure (BP), respiratory sinus arrhythmia (RSA), and endothelial function (assessed via flow-mediated dilation; FMD). An oral glucose tolerance test was used as an indicator of metabolic function. Results: Of the cardiovascular indices, only FMD was significantly associated with PTSD symptoms (CAPS Avoidance symptoms; β = − 0.37, p = .042), and glucose tolerance (β = − 0.44, p = .019), controlling for age and body mass index. The association between FMD and PTSD Avoidance was moderated by RSA such that the effect of FMD was only significant at low levels of RSA (simple slopes β = − 0.87, p = .004). Conclusions: Our results indicate that endothelial function is significantly related to PTSD and glucose tolerance, over and above other cardiovascular measures (HR, BP, RSA). Further, our results suggest that low RSA may be a risk factor for the link between poor endothelial function and PTSD in women with T2DM.

Background: Post-traumatic stress disorder (PTSD) is a stress-related psychiatric disorder that is associated with increased risk for type 2 diabetes mellitus (T2DM). However, the biological mechanisms by which PTSD increases risks for T2DM remain unclear. A growing body of data suggests that dysregulation of the stress axis, including altered glucocorticoid sensitivity and innate immune activity, may act to disrupt glycemic control in trauma-exposed individuals with PTSD. To evaluate the association between PTSD, glycemic regulation, neuroendocrine function and immune activity, we examined associations between PTSD diagnosis and PTSD symptom severity and metabolic, glucocorticoid, and immune biomarkers in trauma-exposed women with T2DM. Methods: We recruited a sample of (N = 63) African-American women with T2DM and high rates of lifetime trauma exposure from the primary care and diabetes specialty clinic waiting rooms of Grady Memorial Hospital, a large county hospital and level 1 trauma center in Atlanta, Georgia. PTSD diagnosis and PTSD symptom severity were determined using the Clinician-Administered PTSD Scale (CAPS). A fasting blood sample was collected and a study physician performed a general medical assessment for each participant. Blood was assayed for hemoglobin A1c (HbA1c) and calculation of average estimated glucose (AEG) concentrations. Peripheral blood mononuclear cells (PBMCs) were extracted and assayed for nuclear factor-κB (NF-κB) pathway activity and monocyte glucocorticoid sensitivity (expressed as dexamethasone [DexIC50]) using previously validated methods. Results: Women with current PTSD had significantly higher levels of HbA1c (p = 0.006) and AEG (p = 0.008) compared to women without PTSD. Furthermore, DexIC50 (p = 0.003) and NF-κB pathway activity (p = 0.013) were increased significantly in women with PTSD as compared to women without PTSD. PTSD symptom severity was predictive of higher DexIC50 (r = 0.27; p = 0.05), denoting decreased glucocorticoid sensitivity), higher HbA1c (r = 0.28; p = 0.024), higher AEG (r = 0.27; p = 0.033), and higher NF-κB pathway activity (r = 0.38; p = 0.023). Increased NF-κB pathway activity was associated with higher HbA1c (r = 0.34; p = 0.05), but not with DexIC50 (r = 0.023; p = 0.91). Conclusions: PTSD diagnosis and PTSD symptom severity are positively associated with worsened glycemic regulation in African-American women with T2DM. In addition, PTSD diagnosis and PTSD symptom severity are also positively associated with increased monocyte glucocorticoid resistance and increased innate immune activity. These data suggest mechanisms of shared pathophysiology and risk connecting PTSD and T2DM which are both significant public health problems. Increased understanding of shared pathophysiology between stress-related psychiatric and medical disorders such as PTSD and T2DM may lead to novel approaches to prevention and progression of disease and argues for improved integration of care for psychiatric and medical disorders.