After the September 11 terrorist attacks, Americans across the country, including children, had substantial symptoms of stress. Even clinicians who practice in regions that are far from the recent attacks should be prepared to assist people with trauma-related symptoms of stress.

More than 2 decades have passed since the end of the Cambodian civil war and the subsequent resettlement of refugees in the United States; however, this population continues to have high rates of psychiatric disorders associated with trauma.

Contrary to unidimensional conceptions of optimism and pessimism, factor analysis of 2 widely used instruments revealed that optimism and pessimism are empirically differentiable, but related, constructs. Moreover, consistent with expectations, optimism and pessimism were differentially linked with fundamental dimensions of mood and personality. Pessimism was principally associated with neuroticism and negative affect. Optimism was primarily associated with extraversion and positive affect. Findings are discussed with reference to current conceptual and measurement models of optimism and pessimism and their relations to broad dimensions of mood and personality.

Objective. Consumer assessments of health care provide important information about how well health plans and clinicians meet the needs of the people they serve. The purpose of this study was to examine whether consumer reports and ratings of care in Medicaid managed care vary by race/ethnicity and language. Data Sources. Data were derived from the National CAHPS s Benchmarking Database (NCBD) 3.0 and consisted of 49,327 adults enrolled in Medicaid managed care plans in 14 states in 2000. Data Collection. The CAHPS s data were collected by telephone and mail. Surveys were administered in Spanish and English. The response rate across plans was 38 percent. Study Design. Data were analyzed using linear regression models. The dependent variables were CAHPS s 2.0 global rating items (personal doctor, specialist, health care, health plan) and multi-item reports of care (getting needed care, timeliness of care, provider communication, staff helpfulness, plan service). The independent variables were race/ethnicity, language spoken at home (English, Spanish, Other), and survey language (English or Spanish). Survey respondents were assigned to one of nine racial/ ethnic categories based on Hispanic ethnicity and race: White, Hispanic/Latino, Black/ African American, Asian/Pacific Islanders, American Indian/Alaskan native, American Indian/White, Black/White, Other Multiracial, Other Race/Ethnicity. Whites, Asians, and Hispanics were further classified into language subgroups based on the survey language and based on the language primarily spoken at home. Covariates included gender, age, education, and self-rated health. Principal Findings. Racial/ethnic and linguistic minorities tended to report worse care than did whites. Linguistic minorities reported worse care than did racial and ethnic minorities.Conclusions. This study suggests that racial and ethnic minorities and persons with limited English proficiency face barriers to care, despite Medicaid-enabled financial access. Health care organizations should address the observed disparities in access to care for racial/ethnic and linguistic minorities as part of their quality improvement efforts.

In either the 5- or 10-item version, PEPPI is a valid and reliable measure of older patients' perceived self-efficacy in interacting with physicians. This instrument may be useful in measuring the impact of empowerment interventions to increase older patients' personal sense of effectiveness in obtaining needed health care.

This 3-wave longitudinal study examined the natural course of posttraumatic stress disorder symptoms using data collected from young adult survivors of community violence. Three key findings emerged. 1. Mean levels of distress for each symptom cluster decreased over time, with reexperiencing decreasing most rapidly. 2. Cross-lagged panel analysis revealed that hyperarousal strongly influences, but is not generally influenced by, other symptoms clusters. 3. Trajectory analysis demonstrated that respondents for whom hyperarousal was the most pronounced baseline symptom showed lower overall symptom improvement relative to trauma exposed counterparts for whom hyperarousal was a less prominent early symptom. Implications for theory, research, and clinical practice are discussed.

Cross-lagged panel analysis of interview data collected from survivors of traumatic physical injury (N = 677) was used to examine the temporal relationship between anxiety sensitivity and posttraumatic stress disorder (PTSD) symptom severity. The two constructs were assessed at three time points: within days of physical injury, at 6-month follow-up and at 12-month follow-up. Results indicated that anxiety sensitivity and PTSD symptom severity were reciprocally related such that anxiety sensitivity predicted subsequent PTSD symptom severity and symptom severity predicted later anxiety sensitivity. Findings have both theoretical and clinical implications.

The construct validity and predictive utility of dispositional optimism were examined in a sample of 192 women professionals. By using covariance structure modeling with latent variables, opotimism (Scheier & Carver, 1985) and self-mastery (Pearlin & Schooler, 1978) were found to be empirically distinct, although substantially correlated, constructs. Furthermore, although optimism and self-mastery were significant and negatively correlated with symptoms of depression, only self-mastery was independently associated with symptom levels. In addition, no evidence was found that optimism and self-mastery interact to influence depressive symptoms. These results suggest that the apparent predictive power of optimism may derive from its substantial overlap with self-mastery. Implications for the assessment and interpretation of optimism and self-mastery are discussed.