Kathryn Macia is a postdoctoral fellow in VA's Advanced Fellowship Program in Mental Illness Research and Treatment at the National Center for PTSD, Dissemination & Training Division, VA Palo Alto Health Care System and the Department of Psychiatry and Behavioral Sciences, Stanford University. Her research interests focus on traumatic stress, substance use, emotion regulation, social support, interpersonal functioning, and homelessness among veterans and vulnerable populations, as well as advanced statistical methods.

Professional Education

  • Ph.D., Palo Alto University, Clinical Psychology (2019)
  • B.S., College of Charleston, Psychology; minor: Mathematics (2010)

Stanford Advisors


All Publications

  • Criminal recidivism among justice-involved veterans following substance use disorder residential treatment. Addictive behaviors Blonigen, D. M., Macia, K. S., Smelson, D., Timko, C. 2020; 106: 106357


    Veterans in treatment for substance use disorders (SUD) often report past criminal offending. However, the rate of criminal recidivism in this population is unknown. Further, prior research in veterans has not examined personality factors as predictors of recidivism, despite the prominence of such factors in leading models of recidivism risk management. We examined these issues in a secondary data analysis of 197 military veterans with a history of criminal offending who were enrolled in an SUD residential treatment program. Participants were interviewed using several measurement instruments at treatment entry, one month into treatment, treatment discharge, and 12months post-discharge. Most veterans (94%) had a history of multiple charges, and 53% had recent involvement in the criminal justice system at the time of treatment entry. In the 12months post-discharge, 22% reported reoffending. In addition, 30% of patients who had been recently involved in the criminal justice system at treatment entry reoffended during follow-up. Higher friend relationship quality (OR=2.32, 95% CI [1.03, 5.21]) at treatment entry and higher staff ratings of patients' relationship quality with other residents during treatment (OR=2.76, 95% CI [1.40, 5.41]) predicted lower odds of recidivism post-discharge. After accounting for these factors, smaller reductions during treatment in the personality trait of Negative Emotionality predicted an increased risk for criminal recidivism post-discharge (OR=1.13, 95% CI [1.01, 1.26]). Results support augmenting the curriculum of SUD programs for veterans with services aimed at reducing risk for criminal recidivism, with a focus on interventions that directly target patients' social support networks and tendencies towards negative emotionality.

    View details for DOI 10.1016/j.addbeh.2020.106357

    View details for PubMedID 32120199

  • The Impact of Item Misspecification and Dichotomization on Class and Parameter Recovery in LCA of Count Data MULTIVARIATE BEHAVIORAL RESEARCH Macia, K. S., Wickham, R. E. 2019; 54 (1): 113–45


    Mixture analysis of count data has become increasingly popular among researchers of substance use, behavioral analysis, and program evaluation. However, this increase in popularity seems to have occurred along with adoption of some conventions in model specification based on arbitrary heuristics that may impact the validity of results. Findings from a systematic review of recent drug and alcohol publications suggested count variables are often dichotomized or misspecified as continuous normal indicators in mixture analysis. Prior research suggests that misspecifying skewed distributions of continuous indicators in mixture analysis introduces bias, though the consequences of this practice when applied to count indicators has not been studied. The present work describes results from a simulation study examining bias in mixture recovery when count indicators are dichotomized (median split; presence vs. absence), ordinalized, or the distribution is misspecified (continuous normal; incorrect count distribution). All distributional misspecifications and methods of categorizing resulted in greater bias in parameter estimates and recovery of class membership relative to specifying the true distribution, though dichotomization appeared to improve class enumeration accuracy relative to all other specifications. Overall, results demonstrate the importance of accurately modeling count indicators in mixture analysis, as misspecification and categorizing data can distort study outcomes.

    View details for DOI 10.1080/00273171.2018.1499499

    View details for Web of Science ID 000467758900008

    View details for PubMedID 30595072

  • Examining cross-level effects in dyadic analysis: A structural equation modeling perspective. Behavior research methods Wickham, R. E., Macia, K. S. 2019; 51 (6): 2629–45


    The actor-partner interdependence (APIM) and common-fate (CFM) models for dyadic data are well understood and widely applied. The actor and partner coefficients estimated in the APIM reflect the associations between individual-level variance components, whereas the CFM coefficient describes the association between dyad-level variance components. Additionally, both models assume that the theoretically relevant and/or empirically dominant component of variability resides at the same level (individual or dyad) across the predictor and outcome variables. The present work recasts the APIM and CFM in terms of dyadic nonindependence, or the extent to which a given variable reflects dyad- versus individual-level processes, and describes a pair of hybrid actor-partner and common-fate models that connect variance components residing at different levels. A series of didactic examples illustrate how the traditional APIM and CFM can be combined with the hybrid models to describe mediational processes that span the individual and dyad levels.

    View details for DOI 10.3758/s13428-018-1117-5

    View details for PubMedID 30203162

  • Mindfulness and Mantra Training for Disaster Mental Health Workers in the Philippines MINDFULNESS Waelde, L. C., Hechanova, M. M., Ramos, P. P., Macia, K. S., Moschetto, J. M. 2018; 9 (4): 1181–90
  • Development and Validation of the Dissociative Symptoms Scale ASSESSMENT Carlson, E. B., Waelde, L. C., Palmieri, P. A., Macia, K. S., Smith, S. R., McDade-Montez, E. 2018; 25 (1): 84–98


    The Dissociative Symptoms Scale (DSS) was developed to assess moderately severe levels of depersonalization, derealization, gaps in awareness or memory, and dissociative reexperiencing that would be relevant to a wide range of clinical populations. Structural analyses of data from four clinical and five nonclinical samples ( N = 1,600) yielded four factors that reflected the domains of interest and showed good fit with the data. Sample scores were consistent with expectations and showed very good internal consistency and temporal stability. Analyses showed consistent evidence of convergent and divergent validity, and posttrauma elevations in scores and in patients with posttraumatic stress disorder provided additional evidence of construct validity. Item response theory analyses indicated that the items assessed moderately severe dissociative experiences. Overall, the results provide support for the reliability and validity of DSS total and subscale scores in the populations studied. Further work is needed to evaluate the performance of the DSS relative to structured interview measures and in samples of patients with other psychological disorders.

    View details for DOI 10.1177/1073191116645904

    View details for Web of Science ID 000416007100007

    View details for PubMedID 27178761

  • Factors associated with emergency department useamong veteran psychiatric patients PSYCHIATRIC QUARTERLY Blonigen, D. M., Macia, K. S., Bi, X., Suarez, P., Manfredi, L., Wagner, T. H. 2017; 88 (4): 721–32


    Frequent utilization of emergency department (ED) services contributes substantially to the cost of healthcare nationally and is often driven by psychiatric factors. Using national-level data from the Veterans Health Administration (VHA), the present study examined patient-level factors associated with ED use among veteran psychiatric patients. Veterans who had at least one ED visit with a psychiatric diagnosis in fiscal years 2011-2012 (n = 226,122) were identified in VHA administrative records. Andersen's behavioral model of healthcare utilization was used to identify need, enabling, and predisposing factors associated with frequency of ED use (primary outcome) in multivariate regression models. Greater ED use was primarily linked with need (psychotic, anxiety, personality, substance use, and bipolar disorders) and enabling (detoxification-related service utilization and homelessness) factors. Chronic medical conditions, receipt of an opioid prescription, and predisposing factors (e.g., younger age) were also linked to greater ED use; however, the effect sizes for these factors were markedly lower than those of most psychiatric and psychosocial factors. The findings suggest that intensive case management programs aimed reducing frequent ED use among psychiatric patients may require greater emphasis on homelessness and other psychosocial deficits that are common among these patients, and future research should explore cost-effective approaches to implementing these programs.

    View details for PubMedID 28108941

  • Contributions of risk and protective factors to prediction of psychological symptoms after traumatic experiences COMPREHENSIVE PSYCHIATRY Carlson, E. B., Palmieri, P. A., Field, N. P., Dalenberg, C. J., Macia, K. S., Spain, D. A. 2016; 69: 106–15


    Traumatic experiences cause considerable suffering and place a burden on society due to lost productivity, increases in suicidality, violence, criminal behavior, and psychological disorder. The impact of traumatic experiences is complicated because many factors affect individuals' responses. By employing several methodological improvements, we sought to identify risk factors that would account for a greater proportion of variance in later disorder than prior studies.In a sample of 129 traumatically injured hospital patients and family members of injured patients, we studied pre-trauma, time of trauma, and post-trauma psychosocial risk and protective factors hypothesized to influence responses to traumatic experiences and posttraumatic (PT) symptoms (including symptoms of PTSD, depression, negative thinking, and dissociation) two months after trauma.The risk factors were all significantly correlated with later PT symptoms, with post-trauma life stress, post-trauma social support, and acute stress symptoms showing the strongest relationships. A hierarchical regression, in which the risk factors were entered in 6 steps based on their occurrence in time, showed the risks accounted for 72% of the variance in later symptoms. Most of the variance in PT symptoms was shared among many risk factors, and pre-trauma and post-trauma risk factors accounted for the most variance.Collectively, the risk factors accounted for more variance in later PT symptoms than in previous studies. These risk factors may identify individuals at risk for PT psychological disorders and targets for treatment.

    View details for PubMedID 27423351

    View details for PubMedCentralID PMC5381967

  • Identifying Classes of Conjoint Alcohol and Marijuana Use in Entering Freshmen PSYCHOLOGY OF ADDICTIVE BEHAVIORS Haas, A. L., Wickham, R., Macia, K., Shields, M., Macher, R., Schulte, T. 2015; 29 (3): 620–26


    The current study identified classes of conjoint marijuana and alcohol use in entering college freshmen using latent profile analysis (N = 772; 53% male, 60% White; Mage = 18). Results yielded 4 distinct groups: Class 1 (moderate drinking with recent marijuana use: 22% of sample), Class 2 (moderate drinking with no recent marijuana use: 25%), Class 3 (light drinking with no recent marijuana use: 40%) and Class 4 (heavy drinking with recent marijuana use: 14%). Separate pairwise contrasts examined cross-class differences in demographics and drinking behaviors, comparing differences in drinking when current marijuana use was controlled (Class 1 vs. 4) and differences in marijuana use when drinking was held relatively constant (Class 1 vs. 2). Among moderate drinkers, recent marijuana users were more likely to drink more than intended, drink to get drunk, and had more problems (including higher rates of blackouts, physical injury, and DUI) relative to peers who refrained from marijuana. No cross-class differences were found for alcohol expectancies or behavioral motives. Findings from these analyses show the presence of distinct groups of conjoint users with different drinking behaviors and consequence profiles, and suggest that conjoint alcohol-marijuana use may be more problematic overall than single substance involvement and highlight the need for developing campus prevention and intervention programs that address the increased risk from polysubstance involvement.

    View details for DOI 10.1037/adb0000089

    View details for Web of Science ID 000361833900012

    View details for PubMedID 26168228

  • Care and caring in the intensive care unit: Family members' distress and perceptions about staff skills, communication, and emotional support JOURNAL OF CRITICAL CARE Carlson, E. B., Spain, D. A., Muhtadie, L., McDade-Montez, L., Macia, K. S. 2015; 30 (3): 557-561


    Family members of intensive care unit (ICU) patients are sometimes highly distressed and report lower satisfaction with communication and emotional support from staff. Within a study of emotional responses to traumatic stress, associations between family distress and satisfaction with aspects of ICU care were investigated.In 29 family members of trauma patients who stayed in an ICU, we assessed symptoms of depression and posttraumatic stress disorder (PTSD) during ICU care. Later, family members rated staff communication, support, and skills and their overall satisfaction with ICU care.Ratings of staff competence and skills were significantly higher than ratings of frequency of communication, information needs being met, and support. Frequency of communication and information needs being met were strongly related to ratings of support (rs = .75-.77) and staff skills (rs = .77-.85), and aspects of satisfaction and communication showed negative relationships with symptoms of depression (rs = -.31 to -.55) and PTSD (rs = -.17 to -.43).Although satisfaction was fairly high, family member distress was negatively associated with several satisfaction variables. Increased understanding of the effects of traumatic stress on family members may help staff improve communication and increase satisfaction of highly distressed family members.

    View details for DOI 10.1016/j.jcrc.2015.01.012

    View details for Web of Science ID 000353400100023

    View details for PubMedID 25682345

  • Traumatic Stressor Exposure and Post-Traumatic Symptoms in Homeless Veterans MILITARY MEDICINE Carlson, E. B., Garvert, D. W., Macia, K. S., Ruzek, J. I., Burling, T. A. 2013; 178 (9): 970–73


    To better understand potential risk factors for post-traumatic stress disorder (PTSD) and homelessness in veterans, we studied trauma exposure and responses in archival data on 115 homeless veterans.Rates of exposure to military and a variety of civilian high magnitude stressor (HMS) and persistent post-traumatic distress (PPD) events and symptoms of post-traumatic stress were assessed. The relationships between frequency of different trauma types and symptoms of post-traumatic stress were examined.Exposure to both HMS and PPD events were extremely high in this sample, with particularly high exposure to adult (82%) and childhood (62%) interpersonal violence HMS events and HMS events during military service (53%). Exposure to both military and civilian PPD events was associated with significantly higher levels of PTSD symptoms than exposure to no PPD events or only civilian PPD events, and almost all HMS event types were significantly correlated with both PTSD and dissociation symptoms.Post-traumatic symptoms and military and civilian traumatic stressors of all types should be assessed in homeless veterans because they may be contributing to poor social and occupational functioning.

    View details for DOI 10.7205/MILMED-D-13-00080

    View details for Web of Science ID 000340805500012

    View details for PubMedID 24005545

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