This paper presents an assessment of how moderating variables may reduce PTSD symptoms for females who have experienced sexual assault. The study examined whether higher levels of assertiveness, religiosity, and perceived social support would result in fewer PTSD symptoms for female sexual assault survivors. Moderation analysis was used to determined if any of the moderator variables significantly reduced PTSD symptom severity for these women, thus leading to potential evidence based treatment for female sexual assault survivors. Implications and suggestions for future research will be provided. Keywords: sexual, assault, PTSD, moderators, women.

This study examined the relations between perceived social support (PSS), negative social interactions (NSI), self-blame, posttraumatic stress disorder (PTSD) symptoms, and gender in adult sexual assault survivors. Participants (N = 315) were recruited from introductory psychology courses at a Midwestern university and from Amazon Mechanical Turk, and had to report at least one sexual assault experience since the age of fourteen in order to be eligible. After being screened for eligibility, participants completed a series of self-report questionnaires online, and received either course credits or a small monetary sum for their participation. As hypothesized, self-blame partially explained the relation between PSS and PTSD in the total sample, and partially explained the relation between PSS and PTSD. Similar results were found for NSI. These two models were not equivalent by gender, as expected. Post-hoc analyses suggest that PSS may have more influence on PTSD for women than for men, and vice versa for NSI. Additionally, self-blame was a significant predictor of PTSD in men but not in women. Clinical implications and future research directions are discussed.

Sexual assault is a major public health crisis, with national epidemiological studies reporting that approximately one-in-five women will be sexually assaulted in their lifetime. Experiential and empirical data indicate that sexual assault causes significant distress for those who experience it, with approximately one-third of sexual assault survivors evidencing lifetime posttraumatic stress disorder (PTSD). In recent years, there have been increasing calls to expand recognition of PTSD beyond its binary framing and to incorporate contextual variables into the study of PTSD so that understandings of posttraumatic stress are more fully situated within the context of trauma survivors' lives. The current study responds to these stated needs. This study utilized two waves of a longitudinal data set in which sexual assault survivors were surveyed annually about their posttraumatic stress symptoms and social support. Using this data, I conducted a latent transition analysis (LTA) to identify latent classes of posttraumatic stress experiences and model the probability of transitioning between latent classes over time. With the goal of highlighting existing strengths in survivors' communities and better understanding optimal utilization of those resources, I also incorporated structural and functional social support as predictors of class membership and class transition. Four latent classes emerged at each time point and were named the High Severity, Depressed & Anxious, Avoidant & Reactive, and Low Severity classes. These classes demonstrated both quantitative (i.e., overall severity) and qualitative (i.e., symptom cluster severity) differences. Transition probabilities illustrated a general pattern of de-escalation. As would be expected, de-escalation was more likely when both types of social support were high compared to when both types of social support were low. Notable differences between the latent classes emerged, however, when one type of social support was high and the other was low. Specifically, while participants assigned to the High Severity class at Time 1 were more likely to de-escalate when structural support was high and functional support was low than the reverse, the opposite pattern was true for participants assigned to the Depressed & Anxious class. The intermediate classes identified in this latent class analysis highlight the limitations of categorical understandings of posttraumatic stress in which one either "has" or "does not have" PTSD. These findings support the calls that have been made by researchers and clinicians to introduce a "subclinical" level of PTSD to the Diagnostic and Statistical Manual, while also encouraging nuance beyond what even a subclinical designation would provide. Specifically, while a subclinical designation would reflect some amount of quantitative variation between the latent classes, it would be unlikely to reflect the qualitative differences found in the current study. These qualitative differences were especially relevant to understanding the longitudinal relationship between posttraumatic stress and social support, with functional support appearing to be especially relevant to those in the High Severity class and structural support especially relevant to those in the Depressed & Anxious class. The findings indicate that sexual assault survivors' social support needs may vary based on the specific symptoms that define their experience of posttraumatic stress at a given point in time. These findings also provide guidance for clinical and non-clinical practitioners regarding how to help survivors engage their support networks most effectively in the aftermath of trauma.

ABSTRACT: The current study investigated whether finding meaning in relation to sexual trauma and using mature defense mechanisms would moderate the association between child sexual abuse (CSA) severity and relationship and psychological adjustment in a sample of undergraduate women with a history of child sexual abuse. CSA severity was measured both objectively (i.e., severity of the abusive event) and subjectively (i.e., self-reported perceptions of the severity of the abusive event). As predicted, the interaction of objective CSA severity and mature defenses uniquely predicted one of four aspects of romantic relationship functioning (i.e., dyadic cohesion or doing joint activities with one's partner), which provides strong support for a moderating effect of mature defenses on relationship adjustment for CSA survivors. In addition, Objective CSA Severity X Meaning and Perceived CSA Severity X Meaning were both significantly correlated with various aspects of psychological functioning. Similarly, Objective CSA Severity X Mature Defenses and Perceived CSA Severity X Mature Defenses were significantly correlated with psychological functioning. These findings provide mild support for a possible moderating effect of meaning and mature defenses on psychological adjustment for CSA survivors. Contrary to hypotheses, the interaction of perceived CSA severity and mature defenses was not significantly related to relationship functioning. Also contrary to hypotheses, the interactions of Perceived CSA Severity X Meaning and Objective CSA Severity X Meaning were not significantly related to relationship functioning. Finally, results did not support the hypothesis that relationship functioning would moderate the association between CSA severity (objective and perceived) and psychological adjustment.

The Social Determinants of Mental Health aims to fill the gap that exists in the psychiatric, scholarly, and policy-related literature on the social determinants of mental health: those factors stemming from where we learn, play, live, work, and age that impact our overall mental health and well-being. The editors and an impressive roster of chapter authors from diverse scholarly backgrounds provide detailed information on topics such as discrimination and social exclusion; adverse early life experiences; poor education; unemployment, underemployment, and job insecurity; income inequality, poverty, and neighborhood deprivation; food insecurity; poor housing quality and housing instability; adverse features of the built environment; and poor access to mental health care. This thought-provoking book offers many beneficial features for clinicians and public health professionals: Clinical vignettes are included, designed to make the content accessible to readers who are primarily clinicians and also to demonstrate the practical, individual-level applicability of the subject matter for those who typically work at the public health, population, and/or policy level. Policy implications are discussed throughout, designed to make the content accessible to readers who work primarily at the public health or population level and also to demonstrate the policy relevance of the subject matter for those who typically work at the clinical level. All chapters include five to six key points that focus on the most important content, helping to both prepare the reader with a brief overview of the chapter's main points and reinforce the "take-away" messages afterward. In addition to the main body of the book, which focuses on selected individual social determinants of mental health, the volume includes an in-depth overview that summarizes the editors' and their colleagues' conceptualization, as well as a final chapter coauthored by Dr. David Satcher, 16th Surgeon General of the United States, that serves as a "Call to Action," offering specific actions that can be taken by both clinicians and policymakers to address the social determinants of mental health. The editors have succeeded in the difficult task of balancing the individual/clinical/patient perspective and the population/public health/community point of view, while underscoring the need for both groups to work in a unified way to address the inequities in twenty-first century America. The Social Determinants of Mental Health gives readers the tools to understand and act to improve mental health and reduce risk for mental illnesses for individuals and communities. Students preparing for the Medical College Admission Test (MCAT) will also benefit from this book, as the MCAT in 2015 will test applicants' knowledge of social determinants of health. The social determinants of mental health are not distinct from the social determinants of physical health, although they deserve special emphasis given the prevalence and burden of poor mental health.