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The negotiation of the freedoms and responsibilities introduced as adolescents begin college may be particularly challenging for those with a trauma history and traumatic stress sequelae (posttraumatic stress disorder; PTSD). The present study examined the prevalence of and risk for trauma and PTSD in a large sample of college students. Matriculating students (N = 3,014; 1,763 female, 1,251 male) at two U.S. universities completed online and paper assessments. Sixty-six percent reported exposure to a Criterion A trauma. Nine percent met criteria for PTSD. Female gender was a risk factor for trauma exposure. Gender and socioeconomic status (SES) were associated with trauma severity. Although in bivariate models, gender and SES were associated with PTSD, multivariate analyses suggested this risk was a function of trauma severity. Thus, students enter college with significant trauma histories and PTSD symptoms. Findings highlight the potential for outreach to incoming students with trauma and point to research directions to enhance understanding of the psychological needs of entering college students.

The comparative effectiveness of 12-step and cognitive-behavioral (C-B) models of substance abuse treatment was examined among 3,018 patients from 15 programs at U.S. Department of Veterans Affairs Medical Centers. Across program types, participants showed significant improvements in functioning from treatment admission to a 1-year follow-up. Although 12-step patients were somewhat more likely to be abstinent at the 1-year follow-up, 12-step, C-B, and combined 12-Step-C-B treatment programs were equally effective in reducing substance use and improving most other areas of functioning. The finding of equal effectiveness was consistent over several treatment subgroups: Patients attending the "purest" 12-step and C-B treatment programs, and patients who had received the "full dose" of treatment. Also, patients with only substance abuse diagnoses, those with concomitant psychiatric diagnoses, and patients who were mandated to treatment showed similar improvement at the 1-year follow-up, regardless of type of treatment received. These data provide important new evidence supporting the effectiveness of 12-step treatment.

Objective College matriculation begins a period of transition into adulthood, one that is marked by new freedoms and responsibilities. This transition also is marked by an escalation in heavy drinking and other drug use, and a variety of use-related negative consequences. Trauma and symptoms of posttraumatic stress disorder (PTSD) may affect alcohol and drug problems, and thus may be a point of intervention. Yet no studies have examined trauma, PTSD, and alcohol and drug problem associations during this developmental period. The present study provides such an examination. Method Matriculating college students (N=997) completed surveys in September (T1) and at five subsequent time points (T2-T6) over their first year of college. With latent growth analysis, trajectories of alcohol and drug-related consequences were modeled to examine how trauma (No Criterion A Trauma, Criterion A Only, No PTSD symptoms) and PTSD (partial or full) symptom status predicted these trajectories. Results Results showed substantial risk for alcohol- and other drug-related negative consequences that is conferred by the presence of PTSD at matriculation. Those with both partial and full PTSD started the year with more alcohol and drug consequences. These individuals showed a steeper decrease in consequences in the first semester, which leveled off as the year progressed. Both alcohol and drug consequences remained higher for those in the PTSD group throughout the academic year. Hyper-arousal symptoms showed unique effects on substance consequence trajectories. Risk patterns were consistent for both partial and full PTSD symptom presentations. Trajectories did not vary by gender. Conclusions Interventions that offer support and resources to students entering college with PTSD may help to ameliorate problem substance use and may ultimately facilitate a stronger transition into college and beyond.

provided general guidance and administrative support. This project also benefited from the invaluable contributions of the local coordinators and project assistants at each Veterans Affairs site, as well as the staff at the Program Evaluation and Resource Center. We thank Kristian Gima for his statistical and editorial assistance and Belle Federman for her statistical consultation. Franz Moggi provided comments on the manuscript.

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Despite the availability of specialty posttraumatic stress disorder (PTSD) care within Department of Veterans Affairs (VA) facilities, many VA patients with PTSD do not seek needed PTSD treatment. This study examined institutional and stigma-related barriers to care among a large diverse group of Vietnam and Iraq/Afghanistan veterans who had been diagnosed with PTSD by a VA provider. A total of 490 patients who had not received VA treatment for PTSD in the previous 2 years (31% response rate) were asked about psychological symptoms and reasons for not using care. Stigma related barriers (concerns about social consequences and discomfort with help-seeking) were rated as more salient (rated in the "slightly" to "moderately" problematic range) than institutional factors (not "fitting into" VA care, staff skill and sensitivity, and logistic barriers; rated in the "not at all" to "slightly" problematic range). Regression analyses revealed that younger age and White females were associated with higher ratings on not fitting into VA health care, whereas non-White males were associated with higher ratings on logistic barriers. PTSD symptoms were positively associated with perceived barriers to care, with the most consistent results observed for PTSD avoidance symptoms. Magnitude of effects was generally small, suggesting the possibility that other factors not assessed in this study may also contribute to perceptions of barriers to care. Future research should attend to the effects of stigma, as well as institutional barriers to care, on VA mental health treatment seeking.

OBJECTIVE:To evaluate Breslau's 7-item screen for posttraumatic stress disorder (PTSD) for use in primary care. DESIGN:One hundred and thirty-four patients were recruited from primary care clinics at a large medical center. Participants completed the self-administered 7-item PTSD screen. Later, psychologists blinded to the results of the screen-interviewed patients using the Clinician Administered PTSD Scale (CAPS). Sensitivity, specificity, and likelihood ratios (LR) were calculated using the CAPS as the criterion for PTSD. RESULTS:The screen appears to have test-retest reliability (r =.84), and LRs range from 0.04 to 13.4. CONCLUSIONS:Screening for PTSD in primary care is time efficient and has the potential to increase the detection of previously unrecognized PTSD. tion to PTSD in medical settings is key to providing treatment to this population, because primary care, rather than specialty mental health services, is the point of contact with the health care system for the majority of individuals with PTSD. 9Improving detection of PTSD is a necessary first step to addressing the health and mental health burden experienced by these patients. Several approaches to screening have recently been proposed, ranging from the use of full-length psychometric self-report measures 10,11 to the development of brief, stand-alone screening instruments. 4,12 Ideally, a screen for PTSD would balance the ability to detect cases with the resources required to evaluate and treat cases that screen positive. The current study focuses on a 7-item screen for DSM-IV PTSD developed by Breslau et al. 13 We evaluate the utility of the Breslau screen to identify PTSD in primary care settings.Breslau et al. 13 proposed a 7-item, empirically derived screening scale from interview items that best discriminated individuals with a diagnosis of PTSD in a large epidemiological telephone survey. The screen was designed to follow an event checklist or other assessment of trauma exposure. Their data indicated that cutoff scores of 4 or 5 (the authors' recommend 4) best balanced the screen's sensitivity, the ability to detect patients with PTSD, and specificity, the ability to detect patients who do not have PTSD. Providing follow-up referrals or evaluations to individuals with screen scores of 4 and higher would maximize the number of PTSD cases identified while minimizing the resources allocated to false positive cases. The authors suggest that future studies evaluate the screen using direct comparisons with clinical assessments and populations that include patients over 45 years of age. We investigate the utility of the Breslau screen by direct comparisons with clinical assessments in a VA primary care population with an unrestricted age range. Furthermore, we eliminate the need for a separate assessment of trauma exposure by adding an introductory stem that is brief and reliable as a general reference for exposure. 4 Thus, the screen, as used in the current study, may be administered to patients as a brief stand-alone self-report instrument to i...