Considering context: Current relationship satisfaction in a second-generation model of men's physical intimate partner violence.

Despite a half-century of scholarship devoted to explicating and disrupting the intergenerational transmission of family violence, it remains a prominent and destructive social force in the United States. Theoretical models have posited a variety of historical and concurrent risk and protective factors implicated in the trajectory from childhood violence exposure to adult perpetration. Using a second-generation model of intimate partner violence (IPV), we integrated social learning and attachment conceptualizations to examine pathways from family-of-origin violence to IPV perpetration among adult men. A sample of mixed-sex couples (N = 233) completed self-report measures related to social learning and attachment-based factors (e.g., violence in past relationships, child exposure, IPV attitudes, adult attachment) and participated in a 10-min conversation about a desired area for change in their relationship. Following, each partner participated in a video-mediated-recall procedure assessing their anger volatility and eliciting attributions of their partners' behavior. We tested mediation pathways (consistent with social learning and attachment theories) between violence in men's families of origin and their adult IPV perpetration as a function of relationship satisfaction. The proposed model fit the data well (CFI = 0.95) but had notable modifications from the hypothesized model. Generally, social-learning pathways were more consistent with the data. Relationship satisfaction interacted with some parameters. Results support theoretical advances in understanding IPV. Although exposure to violence in men's family of origin confers risk for later IPV, and a social learning developmental pathway is consistent with results, some of these effects are altered by relationship context.

Pre-existing parental stress and youth internalizing symptoms predict parent-reported COVID-related stress in military families.

Understanding the extent to which youth and families experienced COVID-related stress requires accounting for prior levels of stress and other associated factors. This is especially important for military families, which experience unique stressors and may be reluctant to seek outside help. In this prospective study, we examined the role of pre-pandemic family factors in predicting parent and youth stress during the COVID-19 pandemic. Participants were 234 families with at least one active-duty parent and a 3rd or 5th-grade child. Findings revealed that preexisting factors predicted youth and family COVID-related stress. Specifically, heightened pre-pandemic parental stress and youth internalizing symptoms were significant predictors of COVID-related stress. Implications for mental health professionals and other organizations supporting military parents and families during the COVID-19 pandemic as well as other times of upheaval are discussed.

Revisiting "ill will versus poor skill": Relationship dissatisfaction, intimate partner violence, and observed "communication skills deficits".

For decades, researchers, interventionists, and the lay public have subscribed to the notion that couples low in relationship satisfaction and/or experiencing psychological, physical, or sexual intimate partner violence (IPV) have communication skills deficits. In contrast, experimental studies of communication have concluded that differences were more likely due to partners' "ill will than poor skill." We revisited this debate by recruiting a fairly generalizable sample of couples (N = 291) via random-digit dialing and asking them to discuss two top conflict areas ("at your best" and "as you typically do"), thus measuring will-conscious inhibition of hostility and negative reciprocity and production of positivity (i.e., the "conflict triad"). The conflict triad was observed with the Rapid Marital Interaction Coding System, Second Generation. We found partial support for the hypotheses grounded in Finkel's I3 meta-model. Frequency of hostility was associated with a complicated satisfaction × IPV-extent × conversation type × gender interaction, indicating that couples' communication skills are multi-determined. Unhappier couples showed almost no change in positivity when at their best, whereas happier couples nearly doubled their positivity despite their considerably higher typical positivity mean. Negative reciprocity was associated with satisfaction and IPV-extent but not conversation type, implying that immediate instigation combined with risk factors overwhelms conscious inhibition. Intervention implications are discussed.

Leadership perspectives on facilitators and barriers to sustaining evidence-based prevention interventions in the United States Military.

The U.S. Department of Defense (DoD) aims to prevent suicide, harassment, sexual assault, and partner and child maltreatment by implementing evidence-based behavioral health interventions (EBIs). However, sustaining EBI implementation over time and with fidelity to result in meaningful impacts is a tremendous challenge. We interviewed 35 military leaders in positions to observe, and possibly hinder, the erosions of EBI implementations to learn what distinguishes EBIs that sustain in the military from those that fade away. Thematic analysis identified barriers and supports to EBI sustainment consistent with the Consolidated Framework for Implementation Research, reflecting the domains: outer setting, inner setting, individuals, and innovation. Participants described how factors at different levels of the social ecology interact with each other and emphasized how aspects of military culture (e.g., hierarchical structure, frequent moves, mission focus) can both support and challenge implementing and sustaining behavioral-health EBIs. EBI implementation in the military differs from most civilian settings in that service member participation in certain preventative programs is mandated. The results indicate how policy and practice can strengthen sustained EBI implementation to reduce harm and support service members.

Prevention System Implementation and Reach: Attitudes and Environmental Predictors in a Randomized Controlled Trial of the NORTH STAR Prevention System.

Although many evidence-based interventions are well-established, our understanding of how to effectively implement and sustain those interventions in real-world settings is less well understood. We investigated predictors of implementation and reach in a randomized controlled trial of the NORTH STAR prevention system. One-third of U.S. Air Force (AF) bases worldwide were randomly assigned to NORTH STAR (n = 12) or an assessment-and-feedback-only condition (n = 12). Process data regarding implementation factors were collected from Community Action Team (CAT) members and observations of CAT processes. Results from a series of regression analyses indicated that change in leadership and community support, action planning processes, and perceived approach effectiveness from pre-action planning to follow-up predicted community action plan (CAP) implementation and that changes in barriers to implementation predicted CAP reach. Pre-action planning reports of CAT member self-efficacy and perceived approach effectiveness also predicted CAP implementation at 1-year follow-up. Future directions and practice recommendations are provided.

Evaluating the Effectiveness of NORTH STAR: a Community-Based Framework to Reduce Adult Substance Misuse, Intimate Partner Violence, Child Abuse, Suicidality, and Cumulative Risk.

We evaluated the effectiveness of NORTH STAR, a community assessment, planning, and action framework to reduce the prevalence of several secretive adult problems (hazardous drinking, controlled prescription drug misuse, suicidality, and clinically significant intimate partner violence and child abuse [both emotional and physical]) as well as cumulative risk. One-third of US Air Force (AF) bases worldwide were randomly assigned to NORTH STAR (n = 12) or an assessment-and-feedback-only condition (n = 12). Two AF-wide, cross-sectional, anonymous, web-based surveys were conducted of randomly selected samples assessing risk/protective factors and outcomes. Process data regarding attitudes, context, and implementation factors were also collected from Community Action Team members. Analyzed at the level of individuals, NORTH STAR significantly reduced intimate partner emotional abuse, child physical abuse, and suicidality, at sites with supportive conditions for community prevention (i.e., moderation effects). Given its relatively low cost, use of empirically supported light-touch interventions, and emphasis on sustainability with existing resources, NORTH STAR may be a useful framework for the prevention of a range of adult behavioral health problems that are difficult to impact.

A Randomized, Controlled Trial of the Impact of the Couple CARE for Parents of Newborns Program on the Prevention of Intimate Partner Violence and Relationship Problems.

Effective, accessible prevention programs are needed for adults at heightened risk for intimate partner violence (IPV). This parallel group randomized controlled trial examines whether such couples receiving the American version of Couple CARE for Parents of Newborns (CCP; Halford et al. 2009) following the birth of a child, compared with controls, report fewer first occurrences of clinically significant IPV, less frequent physical and psychological IPV, and improved relationship functioning. Further, we test whether intervention effects are moderated by level of risk for IPV. Couples at elevated risk for IPV (N = 368) recruited from maternity units were randomized to CCP (n = 188) or a 24-month waitlist (n = 180) and completed measures of IPV and relationship functioning at baseline, post-program (when child was 8 months old), and two follow-ups (at 15 and 24 months). Intervention effects were tested using intent to treat (ITT) as well as complier average causal effect (CACE; Jo and Muthén 2001) structural equation models. CCP did not significantly prevent clinically significant IPV nor were there significant main effects of CCP on clinically significant IPV, frequency of IPV, or most relationship outcomes in the CACE or ITT analyses. Risk moderated the effect of CCP on male-to-female physical IPV at post-program, with couples with a planned pregnancy declining, but those with unplanned pregnancies increasing. This study adds to previous findings that prevention programs for at-risk couples are not often effective and may even be iatrogenic for some couples.

A Research Program Testing the Effectiveness of a Preventive Intervention for Couples with a Newborn.

Noxious family environments are associated with a wide range of adverse child outcomes. In order to prevent couple and parent-child relationship problems, a number of programs have been developed for couples with newborns. The current paper describes a program of research evaluating the American version of couple CARE for parents of newborns. This version of CCP was administered to low-income, unmarried couples with a new baby in an uncontrolled demonstration project (Study 1), compared with a waitlist control condition in a randomized controlled trial (Study 2), and evaluated with low-income parents recruited from urban hospitals in two major metropolitan areas of the United States (Study 3 and Study 4). Despite participant satisfaction with CCP, preventive effects of the program were limited and there was one potential iatrogenic effect. Results were likely impacted by major challenges with recruiting participants and maintaining their engagement in CCP for the duration of the program. We discuss methodological differences between this series of studies and previous trials of prevention programs and make recommendations for improving service delivery to at-risk new parents. These results have implications for public policies that aim to benefit children and families.

Los latinos de bajos recursos están expuestos a amplias desigualdades relacionadas con la salud mental en los Estados Unidos. Recientemente, un resurgimiento de relatos antiinmigratorios han llevado a los inmigrantes latinos vulnerables a sufrir considerables factores desencadenantes de estrés contextual con varias consecuencias perjudiciales para su bienestar general, por ejemplo, interrupciones significativas a sus prácticas de crianza. Dentro de este contexto de adversidad, y a pesar de los múltiples beneficios asociados con las intervenciones preventivas de capacitación para padres, la disponibilidad de intervenciones de capacitación para padres contextualmente y culturalmente relevantes siguen siendo limitadas en las comunidades latinas marginadas. Este artículo constituye un aporte a este déficit de conocimiento mediante la presentación de un modelo de aplicación de intervenciones utilizado en la difusión de versiones culturalmente adaptadas de la intervención de base factual, conocida como GenerationPMTO.© El modelo propuesto también describe un proceso de cambio que hemos documentado en la investigación empírica con padres inmigrantes latinos de bajos recursos que han estado expuestos a las intervenciones adaptadas. El manuscrito está organizado en cuatro secciones. Primero, se debate una presentación general del modelo junto con un breve resumen de teorías principales. Luego, se describen los componentes principales del modelo, complementados por la presentación de un caso práctico. Finalmente, se debaten las consecuencias para la prevención y la intervención clínica.

Patterns of psychological health problems and family maltreatment among United States Air Force members.

OBJECTIVES: We sought to identify subgroups of individuals based on patterns of psychological health problems (PH; e.g., depressive symptoms, hazardous drinking) and family maltreatment (FM; e.g., child and partner abuse). METHOD: We analyzed data from very large surveys of United States Air Force active duty members with romantic partners and children. RESULTS: Latent class analyses indicated six replicable patterns of PH problems and FM. Five of these classes, representing ∼98% of survey participants, were arrayed ordinally, with increasing risk of multiple PH problems and FM. A sixth group defied this ordinal pattern, with pronounced rates of FM and externalizing PH problems, but without correspondingly high rates/levels of internalizing PH problems. CONCLUSIONS: Ramifications of these results for intervention are discussed.

Dental Fear and Avoidance in Treatment Seekers at a Large, Urban Dental Clinic.

PURPOSE: The prevalence and correlates of dental fear have been studied in representative population studies, but not in patients presenting for dental treatment. We hypothesized that dental fear among patients presenting at a large, urban college of dentistry would be similar to that of the population (e.g. 11% high dental fear, 17% to 35% moderate or higher fear) and that fear would be associated with avoidance of routine dental care, increased use of urgent dental care and poor oral health. MATERIALS AND METHODS: Participants were 1070 consecutive patients at a large, urban dental care center. All patients completed a clinical interview, including demographics, medical history, dental history and presenting concerns, and behavioral health history. Patients were also asked to rate their dental anxiety/fear on a 1 (none) to 10 (high) scale. RESULTS: Over 20% of patients reported elevated anxiety/fear, of which 12.30% reported moderate and 8.75% high fear. Severity of dental anxiety/fear was strongly related to the likelihood of avoiding dental services in the past and related to myriad presenting problems. CONCLUSIONS: As hypothesized, the prevalence of moderate or higher fear in dental patients was considerable and closely matched that found in general population surveys. Thus, the 'dental home' is an ideal location to treat clinically significant dental anxiety/fear.

The emergence and evolution of infant externalizing behavior.

In the present investigation, we examined the developmental viability of the externalizing behavior construct spanning the period from 8 to 24 months of age. A sample of 274 psychologically aggressive couples was recruited from hospital maternity wards and followed from childbirth through 24 months of age. Mothers and fathers completed questionnaire measures of infant physical aggression, defiance, activity level, and distress to limitations at 8, 15, and 24 months. The developmental viability of externalizing behavior at each age studied was suggested by several results. Physical aggression, defiance, activity level, and distress to limitations reflected the operation of a single underlying externalizing behavior factor. In some cases, these individual facets of externalizing behavior became more strongly associated with one another over time. The externalizing construct exhibited remarkable longitudinal stability, with the stability of physical aggression and defiance increasing with age. The externalizing behavior construct was concurrently and prospectively associated with several factors in its nomological network (e.g., interparental conflict and poor parental bond with the infant). Our findings suggest that externalizing behaviors coalesce into a psychologically meaningful construct by 8 months of infant life. Researchers who seek to chart the emergence of the externalizing behavior construct may now need to look to earlier months.

Identifying unique and shared risk factors for physical intimate partner violence and clinically-significant physical intimate partner violence.

Intimate partner violence (IPV) is a significant public health concern. To date, risk factor research has not differentiated physical violence that leads to injury and/or fear (i.e., clinically significant IPV; CS-IPV) from general physical IPV. Isolating risk relations is necessary to best inform prevention and treatment efforts. The current study used an ecological framework and evaluated relations of likely risk factors within individual, family, workplace, and community levels with both CS-IPV and general IPV to determine whether they were related to one type of IPV, both, or neither for both men and women. Probable risk and promotive factors from multiple ecological levels of influence were selected from the literature and assessed, along with CS-IPV and general IPV, via an anonymous, web-based survey. The sample comprised US Air Force (AF) active duty members and civilian spouses (total N = 36,861 men; 24,331 women) from 82 sites worldwide. Relationship satisfaction, age, and alcohol problems were identified as unique risk factors (in the context of the 23 other risk factors examined) across IPV and CS-IPV for men and women. Other unique risk factors were identified that differed in prediction of IPV and CS-IPV. The results suggest a variety of both established and novel potential foci for indirectly targeting partner aggression and clinically-significant IPV by improving people's risk profiles at the individual, family, workplace, and community levels. Aggr. Behav. 41:227-241, 2015. © 2014 Wiley Periodicals, Inc.

Child maltreatment in DSM-5 and ICD-11.

Child maltreatment is widespread and has a tremendous impact on child victims and their families. Over the past decade, definitions of child maltreatment have been developed that are operationalized, face valid, and can be reliably applied in clinical settings. These definitions have informed the revised Diagnostic and Statistical Manual (American Psychiatric Association, 2013) and are being considered for the International Classification of Disease-11 (World Health Organization). Now that these definitions are available in major diagnostic systems, primary healthcare providers and clinicians who see children and families are poised to help screen for, identify, prevent, and treat child maltreatment. This article reviews the definitions of maltreatment in these diagnostic systems, along with assessment and screening tools, and empirically supported prevention and intervention approaches.

Enhanced definitions of intimate partner violence for DSM-5 and ICD-11 may promote improved screening and treatment.

Nuanced, multifaceted, and content valid diagnostic criteria for intimate partner violence (IPV) have been created and can be used reliably in the field even by those with little-to-no clinical training/background. The use of such criteria such as these would likely lead to more reliable decision making in the field and more consistency across studies. Further, interrater agreement was higher than that usually reported for individual mental disorders. This paper will provide an overview of (a) IPV's scope and impact; (b) the reliable and valid diagnostic criteria that have been used and the adaptation of these criteria inserted in the latest Diagnostic and Statistical Manual of Mental Disorders (DSM) and another adaptation proposed for the forthcoming International Statistical Classification of Diseases and Related Health Problems (ICD); (c) suggestions for screening of IPV in primary care settings; (d) interventions for IPV; and (e) suggested steps toward globally accepted programs.

A new look at the psychometrics of the parenting scale through the lens of item response theory.

The psychometrics of the Parenting Scale's Overreactivity and Laxness subscales were evaluated using item response theory (IRT) techniques. The IRT analyses were based on 2 community samples of cohabiting parents of 3- to 8-year-old children, combined to yield a total sample size of 852 families. The results supported the utility of the Overreactivity and Laxness subscales, particularly in discriminating among parents in the mid to upper reaches of each construct. The original versions of the Overreactivity and Laxness subscales were more reliable than alternative, shorter versions identified in replicated factor analyses from previously published research and in IRT analyses in the present research. Moreover, in several cases, the original versions of these subscales, in comparison with the shortened versions, exhibited greater 6-month stabilities and correlations with child externalizing behavior and couple relationship satisfaction. Reliability was greater for the Laxness than for the Overreactivity subscale. Item performance on each subscale was highly variable. Together, the present findings are generally supportive of the psychometrics of the Parenting Scale, particularly for clinical research and practice. They also suggest areas for further development.

Scoping Review of Postvention for Mental Health Providers Following Patient Suicide.

INTRODUCTION: As suicides among military personnel continue to climb, we sought to determine best practices for supporting military mental health clinicians following patient suicide loss (i.e., postvention). MATERIALS AND METHODS: We conducted a scoping review of the literature using Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. Our initial search of academic databases generated 2,374 studies, of which 122 were included in our final review. We categorized postvention recommendations based on the socioecological model (i.e., recommendations at the individual provider, supervisory/managerial, organizational, and discipline levels) and analyzed them using a narrative synthesizing approach. RESULTS: Extracted recommendations (N = 358) comprised those at the provider (n = 94), supervisory/managerial (n = 90), organization (n = 105), and discipline (n = 69) levels. CONCLUSIONS: The literature converges on the need for formal postvention protocols that prioritize (1) training and education and (2) emotional and instrumental support for the clinician. Based on the scoped literature, we propose a simple postvention model for military mental health clinicians and recommend a controlled trial testing of its effectiveness.

Leveraging technology to increase the disseminability of evidence-based treatment of dental fear: An uncontrolled pilot study.

OBJECTIVES: U.S. and global estimates indicate that over 30% of adults fear receiving dental care, including over 20% who have visited a dentist in the last year, leading to avoidance and degraded oral and systemic health. Although evidence-based cognitive-behavioral treatments for dental fear (CBT-DF) exist, they have little impact on the millions who seek dental care annually because they are not disseminable (6 h of in-chair time, delivered only in person at a few sites). We developed a disseminable CBT-DF stepped-care treatment comprising (Step 1) a mobile-health application and, for those who remain fearful, (Step 2) a 1-h, one-on-one psychological treatment session that allows practice during exposure to the patient's most-feared stimuli. We hypothesized that the treatment would (a) be rated highly on usability and credibility and (b) result in clinically consequential (i.e., lowering fear into the 0-3 "no/low fear" zone) and statistically significant changes in global dental fear. METHOD: Racially/ethnically diverse patients (N = 48) with moderate to severe dental fear were recruited; all completed Step 1, and n = 16 completed Step 2. RESULTS: As hypothesized, users found the stepped-care treatment highly usable, credible, and helpful. Critically, this stepped-care approach produced reductions in patients' dental fear that were both clinically consequential (with half no longer fearful) and statistically significant (d = 1.11). CONCLUSIONS: This usable, credible, stepped-care approach to dental fear treatment holds promise for liberating evidence-based CBT-DF from specialty clinics, allowing broad dissemination.

A Meta-Review to Guide Military Screening and Treatment of Gambling Problems.

INTRODUCTION: Excessive gambling can cause substantial biopsychosocial problems (e.g., difficulties with finances, relationships, mental, and physical health). For military Service Members, it can also result in security clearance denial or revocation, failure to achieve promotions, and premature career termination. Recent congressional mandates have obligated the U.S. Department of Defense to screen for problematic gambling, the predictive values of which are a function of (i) problem prevalence and (ii) tool sensitivity and specificity. This meta-review (i.e., systematic review of systematic reviews) on the screening properties of gambling assessment tools and the effectiveness of treatments for gambling disorder is to inform military services on responding to Service Members' gambling problems. MATERIALS AND METHODS: EBSCO Discovery Service, PubMed, PsycINFO, Ovid Medline, Social Care Online, Epistemonikos, International Health Technology Assessment, and the Cochrane Central Register of Controlled Trials electronic databases were searched up to December 2022 for systematic reviews and meta-analyses on measurements of adult subclinical or gambling, and interventions targeting individuals with GD. Three and four studies were included in each section of the current meta-review (i.e., assessment tools and treatment). For review 1, the estimated risk of bias was assessed using the Risk of Bias in Systematic Reviews. RESULTS: Thirty-one tools were identified through the three systematic reviews. All had modest sensitivities and specificities; combined with low prevalences in the general SM population, positive results would be incorrect 64-99% of the time. However, if screening were conducted with SMs referred for alcohol problems, a positive result on the best screening tools would be correct 76% of the time. Several commonly used treatment approaches had demonstrated efficacy for GD. CONCLUSIONS: The combination of low prevalence of GD and subclinical gambling problems in the general population, coupled with modest sensitivity and specificity, makes screening unfeasible in the general SM population. However, dual-phase screening in higher-prevalence subpopulations (i.e., SMs already identified with substance-abuse or mental-health problems) would be viable. Regarding treatment, several interventions-already used in military healthcare-with extensive empirical track records have been successfully used to treat adults with GD.

Prevention of partner violence by focusing on behaviors of both young males and females.

Historically, the political context of partner physical aggression policy and research has focused on protection of physically victimized women and mandated interventions for male batterers. This emphasis is understandable when one considers the injuries and deaths of women by men. However, physical aggression against partners among teens is a very different phenomenon than battering. Intimate partner violence (IPV) in the form of physical aggression, the focus of this review, often starts in junior high school, and approximately 35% of male and female senior high school students report engaging in IPV. The specific trajectory of IPV varies by sample, but IPV appears to decrease in the late teens or early 20s. IPV is generally reported by both males and females, and not attributable to self-defense. IPV is significantly stable in couples who remain together, but stability appears lower if partners change. Given the importance of physical aggression by both males and females, prevention and early intervention programs need to address relationship factors, and targeted prevention and early intervention would be prudent with young high-risk couples. Decades of intervention programs for batterers have not proven very successful, and IPV appears easier to prevent than treat. Thus, emphasis on prevention of IPV seems both timely and promising. This review is intended for diverse audiences including educational administrators, policy makers, and researchers. It reviews issues such as who and when to target for IPV prevention programs, and it summarizes data relevant to these issues.

Psychological maltreatment: An operationalized definition and path toward application.

Psychological maltreatment (PM) of children has been difficult to define and even more challenging to operationalize consistently. This fact contributes to child PM being under-recognized and under-addressed by professionals that interact with children with mental health, behavioral, and developmental issues; and by systems such as child welfare, clinical and judicial systems. In this paper, we propose a definition of child PM that is both overarching and operationalized in a manner that will support consistent, fair, and unbiased application in applied contexts. The operationalized definition delineates the nature of caregiver acts that can amount to PM, as well as the level of experienced and potential impact of said act (s) that constitute PM. We detail our rationale for the definition. We discuss the need for field trials to establish the utility of the definition. We explain the necessary training and systems that would be required for the definition to be consistently and accurately applied. We believe that this definition has the potential to substantially enhance systems' abilities to recognize and address child PM, and thereby enhance children's and families' wellbeing.