Open Access. Powered by Scholars. Published by Universities.®

Quantitative Psychology Commons

Open Access. Powered by Scholars. Published by Universities.®

Clinical Psychology

Theses/Dissertations

Institution
Keyword
Publication Year
Publication

Articles 1 - 30 of 63

Full-Text Articles in Quantitative Psychology

The Relationship Between Cognitive Impairment In Psychiatric Patients And Readmission Rate To An Inpatient Facility, Cherilyn Isis Schuff Feb 2024

The Relationship Between Cognitive Impairment In Psychiatric Patients And Readmission Rate To An Inpatient Facility, Cherilyn Isis Schuff

Theses and Dissertations

The primary intention of this study was to further understand the impact of assessing cognitive impairment in psychiatric patients, as a mediating factor on readmission rates. Mild cognitive dysfunction impacts a patient’s functional outcomes (Bowie & Harvey, 2006; Davis et al., 2012; Marcantonio, et al., 2001). Little information exists to guide best practices in the treatment of adults with cognitive impairment who are hospitalized for acute conditions (Davis et al., 2012). A cognitive impairment may impact patient prognosis and ability to function outside of a setting focused on stabilization. Neuropsychological testing is a valuable tool in predicting a patient’s cognitive …


Attitudes Towards Mental Health, Spiritual Seeking, And Well-Being, David Mitchell May 2023

Attitudes Towards Mental Health, Spiritual Seeking, And Well-Being, David Mitchell

Electronic Theses and Dissertations

Religion plays a crucial role in many peoples’ lives, shaping the way they interact with the world and react to stressors. The Relational Spirituality Model (Sandage & Shults, 2007) posits that individuals’ relationship with God resembles humans’ relationships with one another. That is, relationships consist of intimacy and closeness as well as independence and time away from each other, otherwise known as dwelling and seeking. Previous literature has analyzed the relationship between spiritual coping and well-being, yet none have analyzed the relationship between spiritual seeking and overall well-being using attitudes towards mental health as a moderator. Participants were 84 undergraduate …


Gottman Processes And Couple Outcomes While Navigating Infertility, Clayton Brigance Feb 2023

Gottman Processes And Couple Outcomes While Navigating Infertility, Clayton Brigance

Dissertations

Infertility remains one of the most difficult relational contexts for couples. However, some research suggests that some couples actually increase their overall satisfaction in their relationship through infertility due to a deeply shared emotional experience. To the knowledge of the author of this dissertation, no studies exist which explain how couples arrive at their relational outcomes through the experience of infertility. These studies within this dissertation add to the present literature by explaining how couples may arrive at their relational outcome through the lens of Gottman Method Couple Therapy (GMCT). For both studies presented here, 902 participants were recruited through …


Evaluating Outcome Factors Of Childhood Emotional Neglect: An Exploratory Factor Analysis, Taylor Levitt Jul 2022

Evaluating Outcome Factors Of Childhood Emotional Neglect: An Exploratory Factor Analysis, Taylor Levitt

Dissertations

Experiencing childhood maltreatment has been shown to have major implications on adult outcomes. Less is known about the outcomes of childhood emotional neglect (CEN). The purpose of this study was to identify factors related to psychological outcomes of CEN within the domains of depression, anxiety, and alexithymia as a precursor to the development of an inventory. One hundred and fifty participant responses on the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Toronto Alexithymia Scale-20 (TAS-20) were collected. Exploratory factor analysis was conducted where nine factors yielded significant results and were titled, “Depressive Symptoms,” “Difficulty Identifying Feelings,” “Usefulness of …


A Job-Demand Resource Theory And Psychological Flexibility Integrated Model Of Police Officer Burnout, Lucas David Baker Jan 2022

A Job-Demand Resource Theory And Psychological Flexibility Integrated Model Of Police Officer Burnout, Lucas David Baker

Dissertations and Theses

Police officers encounter stressors as a result of job responsibilities that contribute to high rates of occupational burnout. Defined by three primary components (emotional exhaustion, depersonalization, and professional inefficacy), burnout is associated with health- and work-related problems among officers. In addition, police agencies incur significant costs associated with burnout due to performance decline and turnover. Officer burnout is also a matter of public interest given that burnout is associated with low prosocial behavior and high use of force. As such, research that aims to explore the formation and maintenance of officer burnout may be consequential for the profession and society …


Equine Assisted Psychotherapy: Implications For Treating Trauma, Kara L. Harrison Psy.D. Jan 2022

Equine Assisted Psychotherapy: Implications For Treating Trauma, Kara L. Harrison Psy.D.

Psychology Doctoral Specialization Projects

Trauma related symptoms and Posttraumatic Stress Disorder (PTSD) have been increasingly recognized for the key roles they occupy in mental health and overall individual well-being within both adult and childhood populations. They often represent significant barriers to the provision of mental healthcare within military populations and individuals diagnosed with serious mental illness (SMI). This original contribution to practice explores the significance of Equine Assisted Psychotherapy as a novel adjunctive approach to treating trauma. symptoms in adults and children. An extensive literature review examines current research and discussion on common definitions and nomenclature. It begins with discussion on the broader areas …


A Qualitative Investigation Into The Trauma Exhibited By First Responders Tackling The Opioid Epidemic In Tennessee, Thalia Sullivan May 2021

A Qualitative Investigation Into The Trauma Exhibited By First Responders Tackling The Opioid Epidemic In Tennessee, Thalia Sullivan

Electronic Theses and Dissertations

Recent increases in opioid overdose rates have changed the role of first responders on the front lines of this national crisis. The present study used a semi-structured qualitative interview to investigate how the increase in opioids, opioid-related harm, and opioid-related death within Tennessee has affected the first responder population. Law enforcement officers, firefighters, and paramedics (N = 30) from rural-serving counties in Tennessee completed a semi-structured interview. Eight themes emerged from the interviews: (1) mental health symptoms, including posttraumatic stress disorder and secondary traumatic stress symptoms; (2) coping behaviors; (3) available resources; (4) barriers to accessing resources; (5) recommendations …


Personal Technology Use, Social Media, And Daily Affect In Emerging Adults, William Crabtree Jan 2021

Personal Technology Use, Social Media, And Daily Affect In Emerging Adults, William Crabtree

Murray State Theses and Dissertations

Personal social and communication technology has been widely adopted by the world in the 21st century. With this widespread worldwide adoption, significant controversy exists debating the effects these social technologies have. Specifically, there is a strong debate in the scientific literature over the psychological effects of social technologies, smartphones, and social media usage. Some arguments are made that modern technology can help improve psychological well-being, whilst others claim it has destroyed a generation of adolescents and merging adults. The present thesis aims to address this debate by exploring the current research from a variety of methodologies about social technology …


Breaking The Cycle: A Longitudinal Study Of Factors That Disrupt Peer Selection And Influence Processes Among Urban Youth, Kelly E. Oconnor Jan 2021

Breaking The Cycle: A Longitudinal Study Of Factors That Disrupt Peer Selection And Influence Processes Among Urban Youth, Kelly E. Oconnor

Theses and Dissertations

Having friends who engage in problem behavior (i.e., aggression, substance use, delinquency) has consistently been linked to adolescents’ own engagement in problem behavior. There are, however, several key gaps in the literature on peer influence. Few studies have considered the influence of friends’ prosocial behavior and there has been limited research to identify promotive factors that influence urban youths’ affiliation with peers who engage in problem and prosocial behavior across early adolescence, a time of heightened susceptibility to peer influence. The purpose of this study was to identify modifiable promotive factors that reduce adolescents’ problem behavior by decreasing exposure to …


It’S All The Rage: An Animated Approach To Screening For Postpartum Depression, Amanda Gorham Dec 2020

It’S All The Rage: An Animated Approach To Screening For Postpartum Depression, Amanda Gorham

Doctoral Dissertations

Postpartum depression presents a complication for mothers which can, in some cases, be severe and even life-threatening. Instruments commonly used to screen for this psychological condition have been challenged by an extensive body of literature, with many mothers being unidentified and even untreated for their symptoms. The presented research introduces a newly developed screening instrument for detecting probable postpartum depression using text-free scenario-based animations, based on the lived experience of the condition as qualified by empirical research and the existing body of literature. Developed items were controlled for quality via Think Aloud Protocol and alignment studies with subject matter experts …


Implicit Bias And Voluntarily Childfree Adults, Virginia Elizabeth Powell Aug 2020

Implicit Bias And Voluntarily Childfree Adults, Virginia Elizabeth Powell

Electronic Theses and Dissertations

This quantitative study aimed to determine if there is a negative bias towards voluntarily childfree adults or an association of negative views and attitudes with voluntarily childfree adults, controlling for other participant characteristics such as race, religion, or sexual orientation. At this stage in the research, voluntarily childfree adults are generally defined as legal adults who have the intention to remain childfree for the rest of their lives, due to reasons other than fertility issues. A negative view or bias is defined as any attitude which is not a desirable interpretation of behavior or lifestyle. A negative bias against voluntarily …


Intersectionality Between Sex/Gender And Race/Ethnicity On Cognitive Trajectories And Development Of Alzheimer’S Disease, Justina Frances Avila-Rieger Jul 2020

Intersectionality Between Sex/Gender And Race/Ethnicity On Cognitive Trajectories And Development Of Alzheimer’S Disease, Justina Frances Avila-Rieger

Psychology ETDs

The current study examined the interactive effects of race/ethnicity and sex/gender on cognitive trajectories of older adults. Participants were a total of 5258 non-Hispanic White (NHW), Black, and Hispanic men and women in the Washington/Hamilton Heights/Inwood Columbia Aging Project. Multiple-group latent growth curve modeling was used to examine trajectories across sex/gender by racial/ethnic groups and to determine the relationship between specific socio-cultural/health indicators and cognitive decline, including childhood socioeconomic position, years of education, adult income and occupation, cardiovascular risk factors, and marital status. Sex/gender differences in baseline cognitive test performance varied as a function of race/ethnicity and racial/ethnic differences in …


Exploring Differential Effects Of Therapeutic Alliance Across Treatment Therapies, Alexandra T. Tonigan Apr 2020

Exploring Differential Effects Of Therapeutic Alliance Across Treatment Therapies, Alexandra T. Tonigan

Individual, Family, and Community Education ETDs

Effects of therapeutic alliance has been widely studied for depression, anxiety, and interpersonal problems and been found to have small to moderate positive outcomes. Consistent findings are lacking, however, regarding the relationship between therapeutic alliance, treatment therapy, and client characteristics, in alcohol use disorder (AUD) treatment.

The current paper utilizes data from Project MATCH to assess the differential effects of therapeutic alliance on 12-month alcohol abstinence across clients receiving Cognitive Behavioral Therapy (CBT), Motivational Enhancement Therapy (MET), and Twelve Step Facilitation (TSF) treatment. Moreover, higher order interactions were explored to determine whether such effects differed across client characteristics. This research …


Contextually Modulated Avoidance Behavior In Rats Post-Pavlovian Extinction, Lauren Branigan Feb 2019

Contextually Modulated Avoidance Behavior In Rats Post-Pavlovian Extinction, Lauren Branigan

Theses and Dissertations

The following study sought to examine the psychological substrates of renewal (e.g.., context dependent extinction processes) for conditioned avoidance behaviors in rats. Using signaled active avoidance conditioning, rats acquired two-way shuttle responding, to two different auditory stimuli. These behaviors were then extinguished through exposure to the auditory stimuli where shuttling behavior was now without consequence. Subjects were then tested for renewal of avoidance in three distinct renewal sequences (e.g., ABA vs ABB, AAB vs AAA, and ABC vs ABB) in three separate groups of rats. It was found that subjects showed more responding to a stimulus presented outside of its …


Psychological Effects Of Training In Martial Arts After Interpersonal Trauma, Alexandro Garcia Vargas Jan 2019

Psychological Effects Of Training In Martial Arts After Interpersonal Trauma, Alexandro Garcia Vargas

Walden Dissertations and Doctoral Studies

Individuals who experience a traumatic event may have an adverse emotional reaction that negatively impacts their quality of life. The purpose of this qualitative phenomenological study was to explore the influence of training in the martial arts as an intervention in the treatment of interpersonal trauma. The biopsychosocial model provided the framework for the study. The research questions addressed the effects of training in the martial arts and the biological, psychological, and social functioning of individuals who had sustained a form of interpersonal trauma. Data were collected from semistructured interviews with 9 participants. Data were analyzed using Moustakas's modified van …


Mentorship Programs, Depression Symptomatology, And Quality Of Life, Tiesha L. Scott Jan 2019

Mentorship Programs, Depression Symptomatology, And Quality Of Life, Tiesha L. Scott

Walden Dissertations and Doctoral Studies

Depression is a debilitating mental health disorder that has the potential to affect an individual's lifespan adversely; adolescents who reside in low-income urban environments are more at risk of developing the disorder. The purpose of this quantitative ex post facto study was to compare depression symptomatology and quality of life rates among emerging adults who enrolled and emerging adults who did not enroll in a mentorship program as an adolescent while in high school. Beck's cognitive model of depression was used as a theoretical foundation to determine how negative schemas are formed in adolescents who show symptoms of depression. The …


Exercise Adherence And Depression, Cory Reed Sullins Jan 2019

Exercise Adherence And Depression, Cory Reed Sullins

Walden Dissertations and Doctoral Studies

In this study, exercise adherence levels were examined from archival data collected from 2004 to 2006 to determine if an association existed with the levels of depression among individuals over 49 in 3 rural community centers. Abundant research has shown that exercise is effective in alleviating depression but has not shown how levels of exercise adherence may impact the efficacy of exercise in the treatment of depression. The focus of the study was to determine if an increase in exercise adherence may be associated with a decrease in the symptoms of depression. An ANCOVA was used to determine if differences …


The Role Of Meaning-Making In Posttraumatic Growth Among Eritrean Refugees With Posttraumatic Stress Disorder, Yacob Tewolde Tekie Aug 2018

The Role Of Meaning-Making In Posttraumatic Growth Among Eritrean Refugees With Posttraumatic Stress Disorder, Yacob Tewolde Tekie

Doctoral Dissertations

The study examined the moderating role of meaning made, meaning making and social support on the relationship between negative life events and posttraumatic stress disorder (PTSD), anxiety and depression as well as the facilitating role of these moderating variables for posttraumatic growth(PTG). Eritrean refugees (N = 135) who were residing in Europe were recruited. The results showed that post-migration living difficulties significantly related with negative outcomes. In addition, the results showed that social support moderated the relationship between the number of traumatic life events and anxiety symptoms. However, meaning made and social support were not significant moderators on the …


Risk Factors For Domestic Homicide: Immigrant & Canadian-Born Populations, Sakthi Kalaichandran Mar 2018

Risk Factors For Domestic Homicide: Immigrant & Canadian-Born Populations, Sakthi Kalaichandran

Electronic Thesis and Dissertation Repository

Domestic violence is a critical human rights issue that can escalate to cases of domestic homicide. Globally, approximately 30% of women in relationships have reported experiencing violence at the hands of an intimate partner. In Canada this pattern is echoed, as over 25% of police-reported violent offences were from victims of domestic abuse. Recent research has revealed that immigrant & refugee victims experience unique risk factors that may render them more vulnerable to this form of violence. Yet, despite this burgeoning research area, and Canada’s diverse population of 6 million immigrants, there is a dearth of research pertaining to domestic …


The Impacts Of Religious Discrimination Towards Anxiety In Diverse Populations, Sharlaine Marie Ortiz-Diaz Jan 2018

The Impacts Of Religious Discrimination Towards Anxiety In Diverse Populations, Sharlaine Marie Ortiz-Diaz

Walden Dissertations and Doctoral Studies

Previous research has indicated that outcomes of depression, anxiety, and suicidal ideation could stem from religious discrimination (RLGD). However, there remains an important gap in the current literature regarding RLGD impacts with non-Muslim populations. Further, the moderating effects of sex, race, and national origin (moderating variables [MVs]) have yielded mixed findings concerning anxiety (dependent variable). The intergroup anxiety theory and the integrated threat theory elaborate on perceived threats and potential anxiety of intergroup dynamics. The purpose of this quantitative study was to examine the role of religious preferences (independent variable), the MVs, and the RLGD-anxiety relationship. The sample consisted of …


Using Instructed Response Times To Compare Inattentive Responding Across Paper And Online Modalities: Measuring Research Participant Inattention, Olivia B. Brooks Jan 2018

Using Instructed Response Times To Compare Inattentive Responding Across Paper And Online Modalities: Measuring Research Participant Inattention, Olivia B. Brooks

EWU Masters Thesis Collection

It is important to examine the equivalence of paper and online data collection methods across several domains. The current study compared paper versus online modalities from a data quality standpoint, with a specific focus on inattentive (i.e., careless) responding by using an easily-implemented method to capture participants’ careless responses: interspersing instructed response items (e.g., “Please select option 3, ‘Strongly disagree,’”) throughout a collection of 15 established measures. A between-subjects design compared the percentage of instructed response items missed (hence, inattentive responses) across three conditions: 1) lab paper, 2) lab online, and 3) non-lab online. The non-lab online condition was predicted …


Development Of The Clark And Becker Scale Of Symptomatology (Cbs): Symptom-Level Item Performance, Michael Clark Jan 2018

Development Of The Clark And Becker Scale Of Symptomatology (Cbs): Symptom-Level Item Performance, Michael Clark

All Master's Theses

Depression and anxiety are common, often comorbid, mental disorders. Many researchers have developed efficient self- and clinician-report measures of depression and anxiety. Most of these existing measures of depression and anxiety measures yield overall or specific subscale scores. The Clark and Becker Scale of Symptomatology (CBS) was designed to measure individual symptoms of depression and anxiety. It utilizes a different type of bipolar scaling to aid in accurate symptom endorsement. Unlike other pre-existing measures, the CBS is designed to be interpreted at the symptom level. The CBS was administered to a nationally representative sample (n = 530). Concurrent validity …


Media Body Images And Males' Body Dissatisfaction, Muscularity, Disordered Eating, And Depression, Diana Carrillo Jan 2018

Media Body Images And Males' Body Dissatisfaction, Muscularity, Disordered Eating, And Depression, Diana Carrillo

Walden Dissertations and Doctoral Studies

Body objectification theories propose that humans have an innate desire to compare themselves with others. When self-objectification is influenced by media exposure to idealized body images, results may be unrealistic self-perceptions and increased risk of depression, eating pathology, and overexercising. Although considerable work has been done to study these processes among women, much less is known about effects of media exposure on adult men. In response to this gap, this quantitative research study examined effects of exposure to an idealized man's body image on men observers' body dissatisfaction and related behaviors. A convenience sample of 119 freshman and sophomore community …


Individual Growth Through Forgiveness: A Multiple Case Study On The Process Of Forgiveness, Bianca Kazoun Jan 2018

Individual Growth Through Forgiveness: A Multiple Case Study On The Process Of Forgiveness, Bianca Kazoun

Walden Dissertations and Doctoral Studies

Psychology researchers have been gathering information regarding the positive effects of forgiveness, demonstrating that they contribute to better overall physical and emotional wellbeing. Individuals who have suffered a transgression can remain in a place of destructive anger and resentment for years. Long-term, these negative states can have deleterious effects emotionally, physically, and socially. Understanding how to help those who are suffering move past their victimization can have a positive impact. It is therefore important to conduct research to better understand forgiveness through the lived experience of individuals who have experienced some form of victimization. Using evolutionary psychology as the theoretical …


Predicting Modification And Revocation Of Insanity Acquittees On Conditional Release Using The Short-Term Assessment Of Risk And Treatability, Heidi Oliver Feb 2017

Predicting Modification And Revocation Of Insanity Acquittees On Conditional Release Using The Short-Term Assessment Of Risk And Treatability, Heidi Oliver

Doctor of Psychology (PsyD)

Violence risk assessment has evolved significantly over the past 50 years. The newest generation of risk assessment tools is intended not only to assess risk but also to inform treatment. The Short-Term Assessment of Risk and Treatability, i.e., the START, is an example of a 4thgeneration tool that identifies risk and protective factors, highlighting the dynamic variables that may decrease risk. As treatment for mentally ill offenders shifts from inpatient hospital environments to community-based treatment settings, a focus on dynamic risk factors is crucial for maintaining safety for patients and the community. This study aimed to identify the predictive validity …


Predictors Of Obesity, Acculturation, And Perceived Stress In Meskhetian Turk (Ahiska) Immigrants In The United States, Zekeriya Temircan Jan 2017

Predictors Of Obesity, Acculturation, And Perceived Stress In Meskhetian Turk (Ahiska) Immigrants In The United States, Zekeriya Temircan

Walden Dissertations and Doctoral Studies

Obesity is a risk factor for chronic diseases among the ethnic minorities for adult immigrants in the United States. There have been many research studies conducted to examine the relationship between the predictors and obesity in minority groups in the United States, that relationship was unknown in Meskhetian Turk (Ahiska) immigrant populations. Guided by social ecological model and acculturation theory, this study examined the predictors of obesity in the Meskhetian Turk (Ahiska) immigrant population in the western United States. Data were collected from 109 participants using CDC's Behavioral Risk Factor Surveillance System, Stephenson Multigroup Acculturation Scale, and Perceived Stress Scale. …


The Relationship Between Depressive Symptoms And Levels Of Lifestyle Activity Among Community-Dwelling Older Adults, Michael D. Gatson Jan 2017

The Relationship Between Depressive Symptoms And Levels Of Lifestyle Activity Among Community-Dwelling Older Adults, Michael D. Gatson

Walden Dissertations and Doctoral Studies

Identifying depressive symptoms in community-dwelling elders has been problematic, due to a lack of resources and training for health clinicians. Previous researchers have indicated that older adults who engage in physical activities can prevent, or mitigate depression, but no model has included this variable in conjunction with factors such as lifestyle or sociodemographic characteristics. In this study, a predictive design was used with a regression analysis. The purpose of this quantitative study was to investigate the relationship between depressive symptoms and the different factors identified in the literature as significant contributors to its prevalence among older community-dwelling adults. Erikson's theory …


The Psychometric Evaluation And Validation Of A Measure Assessing Pharmacological And Social Alcohol Expectancies In Adolescents, Megan Victoria Mcmurray Jun 2016

The Psychometric Evaluation And Validation Of A Measure Assessing Pharmacological And Social Alcohol Expectancies In Adolescents, Megan Victoria Mcmurray

USF Tampa Graduate Theses and Dissertations

Extending prior alcohol expectancy measurement research, this researcher (McMurray, 2013) recently developed the Pharmacological and Social Alcohol Expectancy Scale (PSAES). The PSAES is the only alcohol expectancy measure to date that provides adequate coverage of both social expectancies and the anticipated positive pharmacological effects resulting from alcohol consumption, and was developed and validated in a sample of young adults (aged 18-23). Research has shown that adolescents at high risk for alcohol use disorder (AUD) hold higher expectations of reward from alcohol, suggesting that expectancy patterns may help distinguish at-risk youth. Building upon the previous PSAES validation study, the primary purpose …


The Nature And Structure Of Temperament In Early And Middle Childhood: A Multi-Method Approach, Yuliya Kotelnikova Jun 2016

The Nature And Structure Of Temperament In Early And Middle Childhood: A Multi-Method Approach, Yuliya Kotelnikova

Electronic Thesis and Dissertation Repository

Structural work on the nature of child temperament has lagged far behind parallel research with adults. Further, the structure of extant parent-report questionnaires has been examined only at the higher-order level, using small samples of children. This dissertation addresses this important gap in three studies, examining the lower- and higher-order structure of two widely used parent-reports of child temperament (Studies 1 and 2) and an observational battery of temperament (Study 3). The first study examined the lower- and higher-order structure of the Children’s Behavior Questionnaire (CBQ; Rothbart, Ahadi, Hershey, & Fisher, 2001) in a large community sample of children at …


Examining Internalizing Symptoms In Child And Youth Victims Of Emotional Abuse And Bullying: The Mediating Effects Of Individual And Family Strength Factors In Clinical Samples, Amani M. Elrofaie Apr 2016

Examining Internalizing Symptoms In Child And Youth Victims Of Emotional Abuse And Bullying: The Mediating Effects Of Individual And Family Strength Factors In Clinical Samples, Amani M. Elrofaie

Electronic Thesis and Dissertation Repository

Child and youth experiences of emotional abuse and bullying are harmful interactions by caregivers and peers, which produce adverse mental health and social outcomes (Glaser, 2011). This study examined the relationships between trauma exposure and internalizing outcomes through individual and parenting level strength factors. The study comprised 1,297 child and youth participants, aged 4 to 18, from inpatient and outpatient mental health facilities across Ontario, who were administered the interRAI Child and Youth Mental Health assessment (ChYMH; Stewart, Hirdes et al., 2015) with their parents/caregivers. Generalized linear modelling (Nelder & Wedderburn, 1972) was used to determine the relationships between trauma …