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In this study, we evaluated the validity of selfreported posttraumatic growth (PTG) by assessing the relation between perceived growth and actual growth from pre-to posttrauma. Undergraduate students completed measures tapping typical PTG domains at Time 1 and Time 2 (2 months later). We compared change in those measures with scores on the Posttraumatic Growth Inventory (PTGI; Tedeschi & Calhoun, 1996) for those participants who reported a traumatic event between Time 1 and Time 2 (n = 122). PTGI scores generally were unrelated to actual growth in PTG-related domains. Moreover, perceived growth was associated with increased distress from pre-to posttrauma, whereas actual growth was related to decreased distress, a pattern suggesting that perceived and actual growth reflect different processes. Finally, perceived (but not actual) growth was related to positive reinterpretation coping. Thus, the PTGI, and perhaps other retrospective measures, does not appear to measure actual pre-to posttrauma change.

Previous findings have been mixed about the role of demographic characteristics in medical students' well-being and school experiences when those characteristics were examined in isolation. The aim of this study was to investigate the roles of gender, race and ethnicity, and sexual orientation in medical students' professional well-being and medical school experiences using an intersectional approach. We analyzed data from the 2019-2022 Association of American Medical Colleges Graduation Questionnaire (N = 66,795). The independent variable was intersectional groups, composed of 16 intersectional groups that combined various genders, races and ethnicities, and sexual orientations. The outcome variables were professional well-being (i.e., burnout, career regret) and medical school experiences (i.e., general mistreatment, discrimination, emotional climate, faculty-student interaction, faculty professionalism, and satisfaction with medical education). Given the large sample, we focused on effect sizes versus statistical significance. The intersectional groups differed from each other on all professional well-being and all medical school experience variables except emotional climate, with at least small effect sizes (ηp2 ≥ .01). Black female sexual minority students reported the most negative outcomes on all variables. The largest differences were primarily with White male heterosexual (e.g., discrimination: d = 1.68, 95% CI [1.53, 1.84]) and White female heterosexual (e.g., disengagement: d = 0.63, 95% CI [0.48, 0.79]) students. However, being a member of a greater number of marginalized groups was not necessarily associated with more negative outcomes, and patterns of group differences varied across domains of professional well-being and medical school experiences. Examining the combination of medical students' gender, race and ethnicity, and sexual orientation yielded larger and more consistent effect sizes than examining each factor individually, suggesting that an intersectional approach can identify the unique challenges confronted by medical students from specific demographic groups.

Little is known about the impact of the COVID-19 pandemic on medical students. We examined medical students’ burnout, career regret, and medical school experiences from before to during the pandemic, and differences between students from marginalized and nonmarginalized groups. We analyzed data from 2019 to 2022 Association of American Medical Colleges Year Two Questionnaires ( N  = 52,152) and Graduation Questionnaires ( N  = 66,795). Given large samples, we focused on effect sizes versus statistical significance. All effects of study year were less than small (η 2  < .01) indicating minimal differences in medical students’ burnout, career regret, and school experiences from before (2019) to during (2020–2022) the pandemic. Interactions between study year and demographic characteristics (gender, race-ethnicity, sexual orientation) were less than small; thus, students from marginalized groups were not affected more by the pandemic than others. Across study years, women reported more exhaustion and discrimination than men. Black students reported more discrimination than students from other racial-ethnic groups; bisexual students reported more discrimination than heterosexual students (all d s > 0.20). Differences between students from marginalized and nonmarginalized groups were bigger than the effects of the pandemic, suggesting a need for system-level interventions to foster inclusion in medical education.

Background Posttraumatic stress disorder (PTSD) is a risk factor for obesity, but the range of behaviors that contribute to this association are not known. Purpose The purpose of this study was to examine associations between self-reported PTSD symptoms in 2007, with and without comorbid depression symptoms, and three problematic overeating behaviors in 2010, and to estimate the associations of PTSD-related overeating behaviors with obesity. Methods Cross-sectional and longitudinal analyses included 7438 male ( n  = 2478) and female ( n  = 4960) participants from the Growing Up Today Study (mean age 22–29 years in 2010). Three eating behavior outcomes were assessed: binge eating (eating a large amount of food in a short period of time with loss of control), top quartile of coping-motivated eating (from the Motivations to Eat scale), and top quartile of disinhibited eating (from the Three-Factor Eating Questionnaire). Results PTSD symptoms were associated with two- to threefold increases in binge eating and top-quartile coping-motivated eating; having ≥4 PTSD symptoms, relative to no PTSD symptoms, was associated with covariate-adjusted RRs of 2.7 (95% CI 2.1, 3.4) for binge eating, 2.1 (95% CI 1.9, 2.4) for the top quartile of coping-motivated eating, and 1.5 (95% CI 1.3, 1.7) for the top quartile of disinhibited eating. There was a trend toward PTSD symptoms in 2007 predicting new onset binge eating in 2010. Having depression symptoms comorbid with PTSD symptoms further increased risk of binge eating and coping-motivated eating. All eating behaviors were associated with obesity. Conclusion Clinicians treating patients with PTSD should know of potential comorbid problematic eating behaviors that may contribute to obesity.

Dozens of studies have found that men and individuals without a history of sexual violence tend to endorse more rape myths, including being more likely to blame sexual violence victim-survivors and see them as less credible. Less is known regarding individual differences in other stigmatizing attitudes, such as whether victim-survivors are seen as less likable. We investigated relations between observer gender and sexual victimization history and ratings of victim-survivor likability across two preexisting studies of six total samples. University students in the United States and community members (Study 1 N = 760) read experimental vignettes describing experiences of sexual violence and other less stigmatized traumatic events (e.g., car accident) and answered several questions, including the likability of the individuals described in the vignettes. Study 2 (N = 1,112) replicated the analysis used in Study 1 in a new sample. We preregistered the hypothesis that women and individuals with a sexual violence history would rate sexual violence victim-survivors as more likable than would men and individuals without a history of sexual violence. Linear regression and mixed effect models were conducted to test hypotheses. Most effects related to gender and sexual violence history were nonsignificant. In exploratory analyses, victim-survivors of sexual violence were rated as less likable than individuals who had experienced other forms of trauma regardless of rater gender or sexual violence history, although this effect was slightly less pronounced for younger individuals and those with a history of sexual violence. Across two studies, the most consistent findings were that participant gender did not predict likability ratings and that victim-survivors of sexual violence were rated as less likable than those who had experienced other traumas.

BackgroundThe World Trade Center (WTC) attacks on September 11, 2001 (9/11) resulted in over 2700 fatalities and thousands injured. Injury on 9/11 has been identified as a risk factor for physical and mental health conditions, but the reasons for this are not well understood. In a population exposed to 9/11 and since followed, an in-depth study on the impacts of injury on 9/11 was conducted to identify factors that contribute to long-term functional issues. This report sought to examine factors influencing participation, participant recall of injury status over time, and determinants of injury severity.MethodsEnrollees from the World Trade Center Health Registry who completed all surveys between 2003 and 2016 and initially reported being injured (N = 2699) as well as a sample of non-injured (N = 2598) were considered to be eligible for the Health and Quality of Life 15 Years after 9/11 (HQoL) Study. Predictors of study non-participation and inconsistent recall of injury over time (i.e., discrepant reports) were identified through fitting log binomial models.ResultsParticipation rates were high overall (76.1%) and did not vary by initially reported injury status, although younger (vs. older), non-White (vs. White), and less educated (vs. more educated) enrollees were less likely to participate in the HQoL Study. Discrepant reporting of 9/11 injury status was much more common among enrollees who initially reported being injured on 9/11 (49.6%) compared with those who did not (7.3%). However, those who incurred more severe injuries on 9/11 were less likely to have discrepant reporting over time compared with those with more minor injuries (broken bone vs. sprain: risk ratio = 0.33, 95% Confidence Interval: 0.19, 0.57). Among those who consistently reported that they were injured on 9/11, most injuries occurred as a result of descending down stairs (31.5%) or by tripping and falling (19.9%); although being hit by a falling object was most often associated with high severity injuries (63.2%) compared with other modes of injury.ConclusionsThese findings highlight the methodological issues involved in conducting a study on the long-term impact of injury more than a decade after the initial incident and may be relevant to future investigators. Factors affecting participation rates, such as demographic characteristics, and those related to discrepant reporting over time, such as injury severity, may affect both the internal and external validity of studies examining the long-term impact of injury.

IntroductionPrevious findings have been mixed about the role of demographic characteristics in medical students' well-being and school experiences when those characteristics were examined in isolation. The aim of this study was to investigate the roles of gender, race and ethnicity, and sexual orientation in medical students' professional well-being and medical school experiences using an intersectional approach.MethodWe analyzed data from the 2019-2022 Association of American Medical Colleges Graduation Questionnaire (N = 66,795). The independent variable was intersectional groups, composed of 16 intersectional groups that combined various genders, races and ethnicities, and sexual orientations. The outcome variables were professional well-being (i.e., burnout, career regret) and medical school experiences (i.e., general mistreatment, discrimination, emotional climate, faculty-student interaction, faculty professionalism, and satisfaction with medical education). Given the large sample, we focused on effect sizes versus statistical significance.ResultsThe intersectional groups differed from each other on all professional well-being and all medical school experience variables except emotional climate, with at least small effect sizes (ηp2 ≥ .01). Black female sexual minority students reported the most negative outcomes on all variables. The largest differences were primarily with White male heterosexual (e.g., discrimination: d = 1.68, 95% CI [1.53, 1.84]) and White female heterosexual (e.g., disengagement: d = 0.63, 95% CI [0.48, 0.79]) students. However, being a member of a greater number of marginalized groups was not necessarily associated with more negative outcomes, and patterns of group differences varied across domains of professional well-being and medical school experiences.DiscussionExamining the combination of medical students' gender, race and ethnicity, and sexual orientation yielded larger and more consistent effect sizes than examining each factor individually, suggesting that an intersectional approach can identify the unique challenges confronted by medical students from specific demographic groups.

Moral injury describes the deleterious effects of acts of commission (e.g., killing noncombatants), omission (e.g., failing to prevent a massacre), or betrayal (i.e., by a trusted authority figure) during military service that transgress accepted behavioral boundaries and norms. Transgressive acts are proposed to lead to a guilt- and shame-based syndrome consisting of post-traumatic stress disorder (PTSD) symptoms, demoralization, self-handicapping, and self-injury. In this study, we tested a frequently cited model of moral injury and assessed the associations between potentially transgressive acts, moral injury outcomes, and guilt and fear. Additionally, we sought to clarify the relative contribution of transgressive and nontransgressive/general combat exposure to moral injury. On the basis of previous research and theory, we anticipated that the transgressive acts would be related to outcomes through guilt and that nontransgressive combat exposure would be related to outcomes through fear. Secondary analysis was conducted on data from a sample of combat-exposed male veterans at a Midwestern Veterans Affairs (VA) medical center (N = 190) who participated in a larger parent study on postdeployment readjustment. Structural equation modeling was used to test the pathways from transgressive and nontransgressive combat exposure to PTSD symptoms and suicidality through combat-related guilt and combat-related fear. The institutional review boards of the Midwestern VA medical center and the university of the affiliated researchers approved the study. In total, 38% (n = 72) of the sample reported a potentially transgressive act as one of their three worst traumatic events. The most common potentially transgressive act was killing an enemy combatant (17%; n = 32). In structural equation modeling analyses. potentially transgressive acts were indirectly related to both suicidality (β = 0.09, p < 0.01) and PTSD symptoms (β = 0.06, p < 0.05) through guilt. General combat exposure was indirectly related to PTSD through fear, β = 0.19, p < 0.01. Combat exposure was not directly or indirectly related to suicidality. Overall, these findings suggest that veterans with a history of potentially transgressive acts may present to the VA with a constellation of symptoms that are associated with combat-related guilt. Transgressive acts were identified using a qualitative approach, allowing a broader sampling of this domain. Results were limited by the use of self-report data and by gathering data from participants who were Veterans seeking compensation and pension evaluations for PTSD. The clinical implications suggest that focusing on fear-related outcomes and ignoring guilt- and shame-based reactions may lead to an incomplete case conceptualization. Clinicians working with veterans with moral injury are encouraged to prepare themselves for the discomfiting therapeutic experiences of bearing witness to and empathizing with clients' memories of their actions, which may include atrocities. Effective and empathic treatments that address the guilt and shame associated with transgressive acts are needed to adequately care for returning veterans.