Contents lists available at ScienceDirect Psychiatry Research journal homepage: www.elsevier.com/locate/psychres Rumination and PTSD symptoms among trauma-exposed Latinos in primary care: Is mindful attention helpful? Andres G. Viana a, ⁎ , Daniel J. Paulus a , Monica Garza b , Chad Lemaire b , Jafar Bakhshaie a , Jodi Berger Cardoso c , Melissa Ochoa-Perez b , Jeanette Valdivieso b , Michael J. Zvolensky a,d, ⁎⁎ a Department of Psychology, University of Houston, Houston, TX, USA b Legacy Community Health Services, Houston, TX, USA c Jodi Berger Cardoso, School of Social Work, University of Houston, Houston, TX, USA d The University of Texas MD Anderson Cancer Center, Department of Behavioral Science, Houston, TX, USA ARTICLE INFO Keywords: Rumination Mindfulness PTSD Trauma Latinos ABSTRACT The present investigation examined the moderating role of mindful attention in the relation between rumination and posttraumatic stress (PTS) symptoms (i.e., re-experiencing, avoidance, arousal, and total PTSD symptoms) among trauma-exposed Latinos in a primary care medical setting. It was hypothesized that mindful attention would moderate, or lessen, the relation between rumination and all facets of PTS, even after controlling for clinically relevant covariates. Participants included 182 trauma-exposed adult Latinos (89.0% female; M age = 37.8, SD = 10.6% and 95.1% reported Spanish as their first language) attending a community-based integrated healthcare clinic in the Southwestern United States. Mindful attention was a significant moderator of relations between rumination and all PTS facets. Specifically, rumination and PTSD symptoms were significantly related yet only in the context of low (vs. high) levels of mindful attention. Mindfulness-based skills may offer incre- mental value to established treatment protocols for traumatic stress, especially when high levels of rumination are present. Rumination may also serve to identify those who are at greatest risk for developing PTSD after trauma exposure and, therefore, most likely to benefit from mindfulness-based strategies. 1. Introduction Latinos represent a large and rapidly growing sector in the United States. It is estimated that by 2060 Latinos will comprise almost 30% of the population (Colby and Ortman, 2014), and yet in regard to mental health, Latinos remain a vastly understudied group (Alegría and Woo, 2009; Cochran et al., 2007). The studies that are available, however, report higher rates of posttraumatic stress symptoms (PTS) and post- traumatic stress disorder (PTSD) among Latinos relative to non-Latino Whites (Perilla et al., 2002; Pole et al., 2001, 2008; Schlenger et al., 1992; Zvolensky et al., 2015c). Given the well-documented comorbidity between PTS and PTSD with various forms of psychopathology and overall disability (Goldberg et al., 2014), a clearer understanding of the cognitive-affective processes that place trauma-exposed Latinos at greatest risk for higher PTSD symptoms is both scientifically and clinically important. One factor apt to be associated with increased PTSD symptoms among trauma-exposed Latinos is rumination, a maladaptive cognitive coping strategy characterized by repetitive and focused attention on the causes and consequences of one's negative feelings (Brewin and Holmes, 2003; Morrow and Nolen-Hoeksema, 1990; Seligowski et al., 2015). Importantly, rumination is malleable and hence an optimal treatment target (Morrow and Nolen-Hoeksema, 1990). Cognitive models for the development and maintenance of PTSD suggest that rumination may be commonly used as cognitive avoidance strategy, wherein the person who has experienced a traumatic event engages in perseverative thinking regarding the causes and meaning of the trauma to escape or avoid dealing with emotionally painful memories (Ehlers and Clark, 2000; Ehlers and Steil, 1995). Rather than providing long- term relief, empirical investigations have found that rumination about the trauma is related to more severe traumatic memories and increased PTSD symptomology (Michael et al., 2007). Similarly, longitudinal in- vestigations have found that rumination predicted PTSD symptom se- verity 6 months later, even after controlling for initial PTSD symptom levels (Ehring et al., 2008). Although extant findings for the role of rumination in the etiology and maintenance of PTSD symptoms are compelling, little is known about these associations among Latinos, and the factors that may weaken or strengthen this relationship are yet to be http://dx.doi.org/10.1016/j.psychres.2017.08.042 Received 10 April 2017; Received in revised form 9 August 2017; Accepted 18 August 2017 ⁎ Correspondence to: Department of Psychology, University of Houston, 4849 Calhoun Road, Room 373, Houston, TX 77204, USA. ⁎⁎ Correspondence to: Department of Psychology, University of Houston, 126 Heyne Building, Houston, TX 77204, USA. E-mail addresses: agviana@uh.edu (A.G. Viana), Mjzvolen@central.uh.edu (M.J. Zvolensky). Psychiatry Research xxx (xxxx) xxx–xxx 0165-1781/ © 2017 Elsevier B.V. All rights reserved. Please cite this article as: Viana, A.G., Psychiatry Research (2017), http://dx.doi.org/10.1016/j.psychres.2017.08.042